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General NPI Number Information
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NPI Number | 1306071261
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Entity Type | Organization
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Legal Business Name | RICHARDSON COUNSELING CENTER
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 5909 S ADAMS ST
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City | BARTONVILLE
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State | IL
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Zip | 61607-1983
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Country | US
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Telephone | 309-633-1030
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Fax | 309-633-1051
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Provider Business Mailing Address
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Address Line | 5909 S ADAMS ST
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City | BARTONVILLE
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State | IL
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Zip | 61607-1983
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Country | US
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Telephone | 309-633-1030
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Fax | 309-633-1051
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Authorized Official
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Title or Position | CLINICAL DIRECTOR / OWNER
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Name | CHARISA R. RICHARDSON
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Credential | BA,CADC,NCACII,SAP,C
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Telephone | 309-633-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A-6276-0001-A
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License Number State | IL
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