Healthcare Provider Details

I. General information

NPI: 1679418396
Provider Name (Legal Business Name): OLLIE ROCHELLE RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CARL VINSON PKWY
WARNER ROBINS GA
31088-5817
US

IV. Provider business mailing address

121 CARL VINSON PKWY
WARNER ROBINS GA
31088-5817
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-2365
  • Fax:
Mailing address:
  • Phone: 478-922-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: