Provider Demographics
NPI:1811022486
Name:RICHARDSON, HUBERT WADE JR
Entity Type:Individual
Prefix:MR
First Name:HUBERT
Middle Name:WADE
Last Name:RICHARDSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:HUBERT
Other - Middle Name:WADE
Other - Last Name:RICHARDSON
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:CERTIFIED
Mailing Address - Street 1:4519 E FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-3004
Mailing Address - Country:US
Mailing Address - Phone:559-801-6696
Mailing Address - Fax:
Practice Address - Street 1:4519 E FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3004
Practice Address - Country:US
Practice Address - Phone:559-801-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA02-069995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor