Provider Demographics
NPI:1487120796
Name:RICHARDSON, VALERIE (LPC)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 LEIGHTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3801
Mailing Address - Country:US
Mailing Address - Phone:256-283-4825
Mailing Address - Fax:800-287-9715
Practice Address - Street 1:1419 LEIGHTON AVE STE F
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3801
Practice Address - Country:US
Practice Address - Phone:256-283-4825
Practice Address - Fax:800-287-9715
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL228270Medicaid