=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902102973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LONNIE L RICHARDSON SR. M.S., ALC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2011
-----------------------------------------------------
Last Update Date | 02/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 286 LIMESTONE RD
-----------------------------------------------------
City | MONROEVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36460-4168
-----------------------------------------------------
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 |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | C1743A
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------