Provider Demographics
NPI:1891919841
Name:RICHMOND, ELIZABETH N (PCC-S)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 FAIRHILL RD
Mailing Address - Street 2:C248
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1058
Mailing Address - Country:US
Mailing Address - Phone:216-375-5608
Mailing Address - Fax:216-325-7785
Practice Address - Street 1:12200 FAIRHILL RD
Practice Address - Street 2:C248
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1058
Practice Address - Country:US
Practice Address - Phone:216-375-5608
Practice Address - Fax:216-325-7785
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC007678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional