Provider Demographics
NPI:1861650293
Name:RICHMOND, MARILYN GERTRUDE (MA, NBCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:GERTRUDE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MA, NBCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 SALINAS CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5262
Mailing Address - Country:US
Mailing Address - Phone:910-867-0736
Mailing Address - Fax:
Practice Address - Street 1:7027 SALINAS CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5262
Practice Address - Country:US
Practice Address - Phone:910-867-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103483Medicaid