Provider Demographics
NPI:1144997065
Name:RICHARDSON, DENISE W (P-LPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:W
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AVERY CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2403
Mailing Address - Country:US
Mailing Address - Phone:601-212-5682
Mailing Address - Fax:
Practice Address - Street 1:5422 CLINTON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3050
Practice Address - Country:US
Practice Address - Phone:601-923-1645
Practice Address - Fax:601-923-1634
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health