Provider Demographics
NPI:1952619249
Name:RICHARDSON, STEPHEN RUSSELL I (AAEE)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RUSSELL
Last Name:RICHARDSON
Suffix:I
Gender:M
Credentials:AAEE
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:RUSSELL
Other - Last Name:RICHARDSON
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:AAEE
Mailing Address - Street 1:2046 NW FLANDERS ST
Mailing Address - Street 2:21
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1159
Mailing Address - Country:US
Mailing Address - Phone:503-804-2520
Mailing Address - Fax:
Practice Address - Street 1:1312 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2327
Practice Address - Country:US
Practice Address - Phone:503-535-1150
Practice Address - Fax:503-535-1191
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)