=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750680476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONNIE RICHARDSON COUNSELING SERVICES,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2011
-----------------------------------------------------
Last Update Date | 09/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 E CLAIBORNE ST
-----------------------------------------------------
City | MONROEVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36460-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-593-9611
-----------------------------------------------------
Fax | 251-743-3451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 159
-----------------------------------------------------
City | MONROEVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36461-0159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-593-9611
-----------------------------------------------------
Fax | 251-743-3451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ THERAPIST
-----------------------------------------------------
Name | MR. LONNIE L RICHARDSON SR.
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 251-593-9611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | C1743A
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------