Provider Demographics
NPI:1730736273
Name:RICHMOND, MIRIAM GRACE (MA, LPC, P-RDT)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:GRACE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MA, LPC, P-RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 ARBORCREST CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1424
Mailing Address - Country:US
Mailing Address - Phone:513-214-1473
Mailing Address - Fax:
Practice Address - Street 1:11438 LEBANON RD UNIT H
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-6201
Practice Address - Country:US
Practice Address - Phone:513-485-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101200000X
OHC.2204075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist