Provider Demographics
NPI:1023116340
Name:RICHMOND, ANDREA R (CAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4383 HECKTOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9767
Mailing Address - Country:US
Mailing Address - Phone:484-293-0088
Mailing Address - Fax:484-293-0228
Practice Address - Street 1:4383 HECKTOWN RD STE A
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9767
Practice Address - Country:US
Practice Address - Phone:484-293-0088
Practice Address - Fax:484-293-0228
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)