Healthcare Provider Details

I. General information

NPI: 1023566247
Provider Name (Legal Business Name): ROSA RICHARDSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 INGRAM BLVD
WEST MEMPHIS AR
72301-3423
US

IV. Provider business mailing address

PO BOX 2192
FORREST CITY AR
72336-2192
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-6818
  • Fax: 870-662-6826
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2506007
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: