Healthcare Provider Details

I. General information

NPI: 1902555196
Provider Name (Legal Business Name): CHASTITY MONIQUE RICHARDSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 WHEELER RD STE 365
AUGUSTA GA
30909-6549
US

IV. Provider business mailing address

3633 WHEELER RD STE 365
AUGUSTA GA
30909-6549
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-6866
  • Fax:
Mailing address:
  • Phone: 706-432-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015021
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: