Provider Demographics
NPI:1922972157
Name:RICHARDSON, LESLI ANN (M ED, MA, LLPC)
Entity type:Individual
Prefix:
First Name:LESLI
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:M ED, MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11393 PODUNK AVE NE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9346
Mailing Address - Country:US
Mailing Address - Phone:616-634-6180
Mailing Address - Fax:
Practice Address - Street 1:5242 PLAINFIELD AVE NE STE F
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1084
Practice Address - Country:US
Practice Address - Phone:616-919-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health