MEDICARE: MR. RICHARD ERIC FORDE LPC

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
1	101YP2500X	Professional Counselor	0701013259	VA
2	101YP2500X	Professional Counselor	LPC003018	GA

General Provider Information

NPI Number	:	1366444572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD ERIC FORDE LPC

Provider Business Mailing Address
First Line	:	4625 CHESTER GARDEN LOOP
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1975
Country	:	US
Telephone Number	:	770-780-6815
Fax Number	:

Provider Business Practice Location Address
First Line	:	4625 CHESTER GARDEN LOOP
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1975
Country	:	US
Telephone Number	:	770-780-6815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/16/2024

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Directions to “ MR. RICHARD ERIC FORDE LPC” Practice Location

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