Healthcare Provider Details

I. General information

NPI: 1174184865
Provider Name (Legal Business Name): CHRISTIE SLEIGHER RICHARDSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY PKWY STE 350
MOUNT LAUREL NJ
08054-1149
US

IV. Provider business mailing address

100 CENTURY PKWY STE 350
MOUNT LAUREL NJ
08054-1149
US

V. Phone/Fax

Practice location:
  • Phone: 404-889-4990
  • Fax:
Mailing address:
  • Phone: 856-482-9000
  • Fax: 856-482-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB11275200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number123
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2023-00967
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: