Healthcare Provider Details

I. General information

NPI: 1386581031
Provider Name (Legal Business Name): MAGGIE K RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 COOPER DR
LEXINGTON KY
40502-2409
US

IV. Provider business mailing address

1207 COOPER DR
LEXINGTON KY
40502-2409
US

V. Phone/Fax

Practice location:
  • Phone: 304-669-8311
  • Fax:
Mailing address:
  • Phone: 304-669-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: