Provider Demographics
NPI:1790333078
Name:RICHARDSON, TONI ROCHELLE (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:ROCHELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4319 TALMADGE CIR
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4398
Mailing Address - Country:US
Mailing Address - Phone:202-270-9504
Mailing Address - Fax:240-838-3072
Practice Address - Street 1:4710 AUTH PL STE 510
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4248
Practice Address - Country:US
Practice Address - Phone:301-702-0047
Practice Address - Fax:301-702-0841
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR173020363LP0808X, 163WP0808X
DCRN1007111363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health