Provider Demographics
NPI:1538818414
Name:RICHARDSON, FREDDREKA (MSW, VPA)
Entity type:Individual
Prefix:
First Name:FREDDREKA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSW, VPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 LIGHTHOUSE DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368
Mailing Address - Country:US
Mailing Address - Phone:870-816-7570
Mailing Address - Fax:
Practice Address - Street 1:6515 LIGHTHOUSE DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368
Practice Address - Country:US
Practice Address - Phone:870-816-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker