Provider Demographics
NPI:1912506205
Name:RICHARDSON, REBECCA ANN (MA, R-DMT, LMHC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA, R-DMT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 S GREENMOUNT DR APT 206
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2326
Mailing Address - Country:US
Mailing Address - Phone:434-987-3852
Mailing Address - Fax:
Practice Address - Street 1:620 BLUEBILL CT
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-4519
Practice Address - Country:US
Practice Address - Phone:434-987-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health