Provider Demographics
NPI:1801440128
Name:CRESPO-RICHARDSON, NANCY KATHERINE (LPC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KATHERINE
Last Name:CRESPO-RICHARDSON
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 1:8637 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:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-553101YM0800X
VA0701009047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health