Provider Demographics
NPI:1952184327
Name:RI'CHARD, LATANYA V (CMPSS)
Entity Type:Individual
Prefix:MS
First Name:LATANYA
Middle Name:V
Last Name:RI'CHARD
Suffix:
Gender:F
Credentials:CMPSS
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 1458
Mailing Address - Street 2:
Mailing Address - City:PLANADA
Mailing Address - State:CA
Mailing Address - Zip Code:95365-1458
Mailing Address - Country:US
Mailing Address - Phone:209-775-0025
Mailing Address - Fax:
Practice Address - Street 1:1240 E. PLAZA BLVD. STE 604
Practice Address - Street 2:#374
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:209-775-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-VSOLRD175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist