Healthcare Provider Details

I. General information

NPI: 1811362619
Provider Name (Legal Business Name): NANCY KENYON RICHARDSON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITALITY DRIVE
BERLIN VT
05641
US

IV. Provider business mailing address

PO BOX 1468
MONTPELIER VT
05601-1468
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-4156
  • Fax: 802-223-4332
Mailing address:
  • Phone: 802-223-4156
  • Fax: 802-223-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000694
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0134318
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: