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General NPI Number Information
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NPI Number | 1326411596
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Entity Type | Individual
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Provider Name | CONCHATA S RICHARDS MS, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 3645 MARKETPLACE BLVD STE 130-33
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City | EAST POINT
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State | GA
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Zip | 30344-5747
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Country | US
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Telephone | 470-485-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 LAUREL RIDGE WAY APT 2206
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City | EAST POINT
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State | GA
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Zip | 30344-8002
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Country | US
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Telephone | 770-715-2130
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC012235
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License Number State | GA
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