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NPI Code Detail

MEDICARE: KEVIN RICHARDSON

MEDICARE: KEVIN RICHARDSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorPRC14986DC

General Provider Information

NPI Number : 1043853617
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN RICHARDSON
Provider Business Mailing Address
First Line : 1010 BRICKELL AVE UNIT 2609
Second Line :
City : MIAMI
State : FL
Zip : 33131-3772
Country : US
Telephone Number : 703-539-2679
Fax Number :
Provider Business Practice Location Address
First Line : 1530 WILSON BLVD STE 650
Second Line :
City : ARLINGTON
State : VA
Zip : 22209-2455
Country : US
Telephone Number : 703-539-2679
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2019
Last Update Date : 02/03/2023

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