Provider Demographics
NPI:1629801055
Name:COLON, RICHARD NICHOLAS (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:NICHOLAS
Last Name:COLON
Suffix:
Gender:M
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12272 106TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282-9519
Mailing Address - Country:US
Mailing Address - Phone:504-919-5625
Mailing Address - Fax:
Practice Address - Street 1:12272 106TH ST NE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282-9519
Practice Address - Country:US
Practice Address - Phone:504-919-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND575175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist