Provider Demographics
NPI:1558505859
Name:RICHARDSON, ANTIA (MA, MS)
Entity type:Individual
Prefix:MS
First Name:ANTIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 FLAMINGO LAKES DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-3305
Mailing Address - Country:US
Mailing Address - Phone:407-922-8968
Mailing Address - Fax:
Practice Address - Street 1:804 N HOAGLAND BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4518
Practice Address - Country:US
Practice Address - Phone:407-931-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health