Healthcare Provider Details

I. General information

NPI: 1336780899
Provider Name (Legal Business Name): AVINA LAREE RICHARDS LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W CENTER ST
MILWAUKEE WI
53210-2154
US

IV. Provider business mailing address

6001 W CENTER ST
MILWAUKEE WI
53210-2154
US

V. Phone/Fax

Practice location:
  • Phone: 414-873-1746
  • Fax: 414-393-9773
Mailing address:
  • Phone: 414-873-1746
  • Fax: 414-393-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9147226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: