Healthcare Provider Details

I. General information

NPI: 1932603107
Provider Name (Legal Business Name): JAZZMYNE LEIGH RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 OFFICE PKWY STE 130
WESTERVILLE OH
43082-8645
US

IV. Provider business mailing address

2800 CONRAD DR
COLUMBUS OH
43207-3500
US

V. Phone/Fax

Practice location:
  • Phone: 614-379-3430
  • Fax: 614-547-8034
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: