Provider Demographics
NPI:1972607679
Name:RICHARDSON, RITA JEAN (MED LPCMHSP)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:JEAN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MED LPCMHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:218 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650
Practice Address - Country:US
Practice Address - Phone:423-743-1470
Practice Address - Fax:423-743-1472
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC1721101Y00000X
TN1721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4098444OtherMAGELLAN SUMMIT
351654200OtherDOL WORKERS COMP
VA010150132Medicaid
4098444OtherMAGELLAN NAVIGATOR
620582605OtherTHREE RIVERS PROVI GROUP
4098444OtherMAGELLAN PINNACLE