Provider Demographics
NPI:1700482569
Name:NANCY CRESPO-RICHARDSON LLC
Entity Type:Organization
Organization Name:NANCY CRESPO-RICHARDSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:CRESPO-RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:219-229-2300
Mailing Address - Street 1:8637 MATHIS AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5270
Mailing Address - Country:US
Mailing Address - Phone:571-358-9265
Mailing Address - Fax:
Practice Address - Street 1:8637 MATHIS AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5270
Practice Address - Country:US
Practice Address - Phone:571-358-9265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty