Provider Demographics
NPI:1902652266
Name:RICHARDSON, CHAUNTEL VERNAE (MPH, CHES)
Entity Type:Individual
Prefix:
First Name:CHAUNTEL
Middle Name:VERNAE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PARKDALE PL
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3847
Mailing Address - Country:US
Mailing Address - Phone:856-834-8544
Mailing Address - Fax:
Practice Address - Street 1:5 PARKDALE PL
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3847
Practice Address - Country:US
Practice Address - Phone:856-834-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25240174H00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator