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General NPI Number Information
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NPI Number | 1104536382
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Entity Type | Organization
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Legal Business Name | KIM RICHARDSON THERAPY LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 07/08/2023
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Provider Practice Location Address
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Address Line | 186 S RIVER AVE STE 7
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City | HOLLAND
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State | MI
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Zip | 49423-2848
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Country | US
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Telephone | 312-882-5067
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | SAUGATUCK
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State | MI
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Zip | 49453-0444
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Country | US
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Telephone | 312-882-5067
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Fax |
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Authorized Official
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Title or Position | LMSW, LPC
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Name | KIM ADRIENNE RICHARDSON
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Credential |
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Telephone | 312-882-5067
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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