Provider Demographics
NPI:1831907187
Name:RICHARDS, ANTWON LAMAR (QMHS)
Entity type:Individual
Prefix:
First Name:ANTWON
Middle Name:LAMAR
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 S ASHBURTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1027
Mailing Address - Country:US
Mailing Address - Phone:380-276-9916
Mailing Address - Fax:
Practice Address - Street 1:6561 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3502
Practice Address - Country:US
Practice Address - Phone:614-561-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP665598347C00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No347C00000XTransportation ServicesPrivate Vehicle