Provider Demographics
NPI:1013295526
Name:RICHMOND, ADEYA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ADEYA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 GAMBLE DR STE 395
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1510
Mailing Address - Country:US
Mailing Address - Phone:612-524-8763
Mailing Address - Fax:
Practice Address - Street 1:5353 GAMBLE DR STE 395
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1510
Practice Address - Country:US
Practice Address - Phone:612-524-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical