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General NPI Number Information
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NPI Number | 1629340914
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Entity Type | Organization
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Legal Business Name | DERYCK D. RICHARDSON, PH.D. LLC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 1425 E DUBLIN GRANVILLE RD SUITE 204
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City | COLUMBUS
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State | OH
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Zip | 43229-3325
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Country | US
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Telephone | 614-888-5255
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Fax | 614-888-2306
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Provider Business Mailing Address
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Address Line | 1425 E DUBLIN GRANVILLE RD SUITE 204
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City | COLUMBUS
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State | OH
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Zip | 43229-3325
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Country | US
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Telephone | 614-888-5255
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Fax | 614-888-2306
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DERYCK D'ARCY RICHARDSON
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Credential | PH.D.
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Telephone | 614-888-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 2950
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2950
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License Number State | OH
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