Provider Demographics
NPI:1902921323
Name:RICHARDSON, LEIGH ANN (LPC)
Entity type:Individual
Prefix:MISS
First Name:LEIGH
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1265
Mailing Address - Country:US
Mailing Address - Phone:601-212-0600
Mailing Address - Fax:
Practice Address - Street 1:1743 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1265
Practice Address - Country:US
Practice Address - Phone:601-212-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1214101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor