Provider Demographics
NPI:1619780632
Name:RICHARDS, JUSTIN ALEXANDER (CT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ALEXANDER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 NORWICH ST, SUITE 110, 230
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026
Mailing Address - Country:US
Mailing Address - Phone:844-293-3924
Mailing Address - Fax:
Practice Address - Street 1:5123 NORWICH STREET SUITE 110, 230
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026
Practice Address - Country:US
Practice Address - Phone:844-293-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406267-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.2406267-TRNEOtherCOUNSELOR, SOCIAL WORKER, MFT BOARD