Provider Demographics
NPI:1194056317
Name:RICHARD, JHONKIA (LPC-MHSP, PHD)
Entity type:Individual
Prefix:DR
First Name:JHONKIA
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LPC-MHSP, PHD
Other - Prefix:
Other - First Name:KIA
Other - Middle Name:
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:26 LAMAR CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4121
Mailing Address - Country:US
Mailing Address - Phone:731-234-8227
Mailing Address - Fax:731-736-2530
Practice Address - Street 1:26 LAMAR CIR
Practice Address - Street 2:STE 3
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4121
Practice Address - Country:US
Practice Address - Phone:901-417-3181
Practice Address - Fax:731-736-2530
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
TN0000003455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health