Provider Demographics
NPI:1902102973
Name:RICHARDSON, LONNIE L SR (MS, ALC)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:L
Last Name:RICHARDSON
Suffix:SR
Gender:M
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36461-0159
Mailing Address - Country:US
Mailing Address - Phone:251-593-9611
Mailing Address - Fax:251-743-3451
Practice Address - Street 1:286 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-4168
Practice Address - Country:US
Practice Address - Phone:251-593-9611
Practice Address - Fax:251-743-3451
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1743A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health