Healthcare Provider Details

I. General information

NPI: 1730736273
Provider Name (Legal Business Name): MIRIAM GRACE RICHMOND MA, LPC, P-RDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11438 LEBANON RD UNIT H
CINCINNATI OH
45241-6201
US

IV. Provider business mailing address

3580 ARBORCREST CT
CINCINNATI OH
45236-1424
US

V. Phone/Fax

Practice location:
  • Phone: 513-485-2033
  • Fax:
Mailing address:
  • Phone: 513-214-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2204075
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: