Healthcare Provider Details

I. General information

NPI: 1366996993
Provider Name (Legal Business Name): CHANNING ELIZABETH RICHMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 07/21/2022
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 TELEGRAPH AVE APT 216
OAKLAND CA
94609-3575
US

IV. Provider business mailing address

2919 TELEGRAPH AVE APT 216
OAKLAND CA
94609-3575
US

V. Phone/Fax

Practice location:
  • Phone: 510-604-5217
  • Fax:
Mailing address:
  • Phone: 510-604-5217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120007
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: