Provider Demographics
NPI:1992204465
Name:RICHARDSON, JACQUELINE (LPCC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:4010 DUPONT CIR STE 419
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4837
Mailing Address - Country:US
Mailing Address - Phone:502-409-6993
Mailing Address - Fax:502-409-6775
Practice Address - Street 1:4010 DUPONT CIR STE 419
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4837
Practice Address - Country:US
Practice Address - Phone:502-409-6993
Practice Address - Fax:502-409-6775
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID