Provider Demographics
NPI:1245959865
Name:RICHARDSON, SHONTAY LASHAY (LPCC)
Entity type:Individual
Prefix:
First Name:SHONTAY
Middle Name:LASHAY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TAY
Other - Middle Name:LASHAY
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:10623 CAMINITO CHUECO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2801
Mailing Address - Country:US
Mailing Address - Phone:914-364-8247
Mailing Address - Fax:
Practice Address - Street 1:2729 4TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6223
Practice Address - Country:US
Practice Address - Phone:508-921-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health