Basic Information
| Provider Information | |||||||||
| NPI: | 1790194496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1963 | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481121963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133313435 | ||||||||
| FaxNumber: | 3139240605 | ||||||||
| Practice Location | |||||||||
| Address1: | 23800 W 10 MILE RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480333141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346745751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801097190 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.