Healthcare Provider Details

I. General information

NPI: 1487705315
Provider Name (Legal Business Name): CAROL A. RICHARDS PSYD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 MAIN ST. SUITE 4
KELSEYVILLE CA
95451
US

IV. Provider business mailing address

PO BOX 974
COBB CA
95426-0974
US

V. Phone/Fax

Practice location:
  • Phone: 707-279-4607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: CAROL A. RICHARDS
Title or Position: CLINICIAN
Credential:
Phone: 707-263-0877