MEDICARE: MRS. NYA J S 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
1	101YM0800X	Mental Health Counselor		NC

General Provider Information

NPI Number	:	1962367680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NYA J S RICHARDSON

Provider Business Mailing Address
First Line	:	56 B P CT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-6034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 B P CT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-6034
Country	:	US
Telephone Number	:	252-452-1668
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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