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General NPI Number Information
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NPI Number | 1841488350
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Entity Type | Organization
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Legal Business Name | KEVIN J RICHARDS, PH.D., P.C.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 199 FRASIER ST SE
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City | MARIETTA
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State | GA
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Zip | 30060-2201
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Country | US
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Telephone | 678-310-3442
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Fax | 678-564-4401
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Provider Business Mailing Address
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Address Line | 199 FRASIER ST SE
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City | MARIETTA
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State | GA
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Zip | 30060-2201
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Country | US
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Telephone | 678-310-3442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN J RICHARDS
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Credential | PH.D.
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Telephone | 678-310-3442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002508
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PSY002508
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License Number State | GA
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