Provider Demographics
NPI:1699242875
Name:RICHARDSON, ERIN MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 DUBLIN CT SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1730
Mailing Address - Country:US
Mailing Address - Phone:404-210-8531
Mailing Address - Fax:
Practice Address - Street 1:400 TECHNOLOGY CT SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5237
Practice Address - Country:US
Practice Address - Phone:770-431-2354
Practice Address - Fax:770-436-7143
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00111629225C00000X
GALPC007156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor