Provider Demographics
NPI:1154728855
Name:RICHARDS, CHARLES DONALD (LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DONALD
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1813
Mailing Address - Country:US
Mailing Address - Phone:810-653-6478
Mailing Address - Fax:
Practice Address - Street 1:609 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1813
Practice Address - Country:US
Practice Address - Phone:810-653-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional