Provider Demographics
NPI:1881082212
Name:RICHARDSON, BRIAN (LCPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1545
Mailing Address - Country:US
Mailing Address - Phone:610-816-5728
Mailing Address - Fax:610-816-5710
Practice Address - Street 1:716 N PARK RD
Practice Address - Street 2:STE 1
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2912
Practice Address - Country:US
Practice Address - Phone:610-375-0544
Practice Address - Fax:610-378-9779
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional