Provider Demographics
NPI:1124504253
Name:RICHARDSON, CAROL ELIZABETH (MDIV, MPH)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ELIZABETH
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MDIV, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12803 TWINBROOK PKWY APT 204
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-2446
Mailing Address - Country:US
Mailing Address - Phone:269-365-8939
Mailing Address - Fax:
Practice Address - Street 1:12803 TWINBROOK PKWY APT 204
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-2446
Practice Address - Country:US
Practice Address - Phone:269-365-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No172V00000XOther Service ProvidersCommunity Health Worker
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
EHB205OtherHOLISTIC SERVICES AGENCY
HE304OtherHOLISTIC SERVICES AGENCY