Healthcare Provider Details

I. General information

NPI: 1699398453
Provider Name (Legal Business Name): ANASTASIA ROSE RICHARDSON MS, LCGC, CCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 11/27/2023
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 OAK STREET
VANCOUVER BC
V6H 3N1
CA

IV. Provider business mailing address

305 - 2330 MAPLE STREET
VANCOUVER BC
V6J 3T6
CA

V. Phone/Fax

Practice location:
  • Phone: 604-875-2000
  • Fax: 604-875-2376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGT60789113
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number10467973-3601
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: