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General NPI Number Information
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NPI Number | 1831457878
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Entity Type | Organization
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Legal Business Name | RICHARDSON-MINTZCOUNSELING CENTER
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1211 29TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1905
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Country | US
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Telephone | 205-856-9041
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Fax | 205-854-1694
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Provider Business Mailing Address
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Address Line | 1211 29TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1905
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Country | US
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Telephone | 205-856-9041
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Fax | 205-854-1694
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MISS PAMELA ANN RICHARDSON
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Credential | MA,NCC,CCJTS,JD
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Telephone | 205-856-9041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 07238
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 07238
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License Number State | AL
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