Provider Demographics
NPI:1902238181
Name:RICHARDSON, THERESIA ANNETTE (MAED, LMHCA)
Entity Type:Individual
Prefix:
First Name:THERESIA
Middle Name:ANNETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MAED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 80TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7324
Mailing Address - Country:US
Mailing Address - Phone:425-359-4404
Mailing Address - Fax:
Practice Address - Street 1:16000 BOTHELL EVERETT HWY STE 285
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1505
Practice Address - Country:US
Practice Address - Phone:425-359-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60312899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health