Provider Demographics
NPI:1952100281
Name:RICHARDSON, JAQUETTA DEVONA (QMHP-A)
Entity type:Individual
Prefix:
First Name:JAQUETTA
Middle Name:DEVONA
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-6713
Mailing Address - Country:US
Mailing Address - Phone:804-688-9115
Mailing Address - Fax:
Practice Address - Street 1:2409 INGRAM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-6713
Practice Address - Country:US
Practice Address - Phone:804-688-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732011043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health