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General NPI Number Information
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NPI Number | 1164049391
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Entity Type | Individual
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Provider Name | LACOYA D RICHARDSON RBT, MA
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Gender | Female
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Dates
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Enumeration Date | 07/03/2020
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 4653 DARLINGTON RD
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City | HOLIDAY
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State | FL
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Zip | 34690
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Country | US
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Telephone | 770-316-2633
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Fax |
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Provider Business Mailing Address
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Address Line | 4737 MILE STRETCH DR UNIT 3210
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City | HOLIDAY
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State | FL
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Zip | 34692-9709
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Country | US
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Telephone | 770-316-2633
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-125695
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License Number State | GA
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