Healthcare Provider Details

I. General information

NPI: 1093159451
Provider Name (Legal Business Name): WILLIAM RICHARDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CENTURY PARK S
BIRMINGHAM AL
35226-3946
US

IV. Provider business mailing address

500 CENTURY PARK S
BIRMINGHAM AL
35226-3946
US

V. Phone/Fax

Practice location:
  • Phone: 205-233-1414
  • Fax: 205-991-4829
Mailing address:
  • Phone: 205-233-1414
  • Fax: 205-991-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberWXR-01058632
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19295
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: