Healthcare Provider Details

I. General information

NPI: 1962367680
Provider Name (Legal Business Name): MRS. NYA J S RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 B P CT
ROCKY MOUNT NC
27804-6034
US

IV. Provider business mailing address

56 B P CT
ROCKY MOUNT NC
27804-6034
US

V. Phone/Fax

Practice location:
  • Phone: 252-452-1668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: