Basic Information
| Provider Information | |||||||||
| NPI: | 1790815371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHMOND | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 GRAVENSTEIN HWY N | ||||||||
| Address2: | |||||||||
| City: | SEBASTOPOL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954722607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078237300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1800 GRAVENSTEIN HWY N | ||||||||
| Address2: | |||||||||
| City: | SEBASTOPOL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078237300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSB 34946 | CA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 2012939 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.