Provider Demographics
NPI:1851051353
Name:TODD, RICHARD MATT (MA, LCMHCA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MATT
Last Name:TODD
Suffix:
Gender:M
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ROWANWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-9327
Mailing Address - Country:US
Mailing Address - Phone:919-454-1012
Mailing Address - Fax:
Practice Address - Street 1:106 FOUNTAIN BROOK CIR STE B
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4478
Practice Address - Country:US
Practice Address - Phone:919-297-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health