Provider Demographics
NPI:1508184649
Name:RICHESSON, CAMILLA (LPC)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:RICHESSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 E MARKET ST STE B
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2662
Mailing Address - Country:US
Mailing Address - Phone:717-718-8158
Mailing Address - Fax:717-751-1755
Practice Address - Street 1:3410 E MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2662
Practice Address - Country:US
Practice Address - Phone:717-718-8158
Practice Address - Fax:717-751-1755
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC002774OtherPA BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS