Provider Demographics
NPI:1992313142
Name:BALDWIN, RICHARD L (MA/LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MA/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 GRAND RIVER RD.
Mailing Address - Street 2:
Mailing Address - City:RIVES JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49277
Mailing Address - Country:US
Mailing Address - Phone:517-569-8467
Mailing Address - Fax:
Practice Address - Street 1:6564 GRAND RIVER RD.
Practice Address - Street 2:
Practice Address - City:RIVES JUNCTION
Practice Address - State:MI
Practice Address - Zip Code:49277
Practice Address - Country:US
Practice Address - Phone:517-569-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004088101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional