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General NPI Number Information
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NPI Number | 1073844544
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Entity Type | Individual
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Provider Name | MRS. CASSANDRA LYNN RICHARDSON
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Gender | Female
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Dates
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Enumeration Date | 01/23/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 17200 W 10 MILE RD SUITE 113
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2928
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Country | US
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Telephone | 248-443-1940
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Fax | 586-757-8386
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Provider Business Mailing Address
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Address Line | 13034 CHAMPAIGN AVE
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City | WARREN
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State | MI
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Zip | 48089-1348
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Country | US
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Telephone | 586-944-3798
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Fax | 586-757-8386
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401011793
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License Number State | MI
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