Provider Demographics
NPI:1295253573
Name:RICHARDSON, MATTHEW HENRY (LCPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:HENRY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1464
Mailing Address - Country:US
Mailing Address - Phone:443-797-0144
Mailing Address - Fax:
Practice Address - Street 1:303 INTERNATIONAL CIR STE T125
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1391
Practice Address - Country:US
Practice Address - Phone:443-797-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional