Healthcare Provider Details

I. General information

NPI: 1205129558
Provider Name (Legal Business Name): JENNIFER L. L. RICHARDS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CHARLOTTE AVE STE 101B
SANFORD NC
27330-4363
US

IV. Provider business mailing address

12 THE POINTE
SANFORD NC
27332-8492
US

V. Phone/Fax

Practice location:
  • Phone: 919-205-8325
  • Fax:
Mailing address:
  • Phone: 919-205-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number5686
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04922
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5686
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5686
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: