Provider Demographics
NPI:1811362619
Name:KENYON RICHARDSON, NANCY (LCMHC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KENYON RICHARDSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-1468
Mailing Address - Country:US
Mailing Address - Phone:802-223-4156
Mailing Address - Fax:802-223-4332
Practice Address - Street 1:100 HOSPITALITY DRIVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-223-4156
Practice Address - Fax:802-223-4332
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0134318101YM0800X
VT000694101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health