Healthcare Provider Details

I. General information

NPI: 1659150076
Provider Name (Legal Business Name): RICHARLSON BENJAMIN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 PACES PARK DR
DECATUR GA
30033-7423
US

IV. Provider business mailing address

9305 PACES PARK DR
DECATUR GA
30033-7423
US

V. Phone/Fax

Practice location:
  • Phone: 786-786-8388
  • Fax:
Mailing address:
  • Phone: 786-838-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5092
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002256
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: