Provider Demographics
NPI:1023849478
Name:RICHARDS, NICHOLAS JUWAN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JUWAN
Last Name:RICHARDS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 CLAY DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6000
Mailing Address - Country:US
Mailing Address - Phone:404-996-9961
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS RD BLDG 25
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7232
Practice Address - Country:US
Practice Address - Phone:770-971-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor