Richardson, Clyde A

Richardson, Clyde A is an individual health care provider with primary practice located at 3210 Eagle Run Dr Suite 200, Grand Rapids MI 49525. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Pastoral. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Richardson, Clyde A can be contacted via phone (616) 957-1200.

Contact Information

Primary practice address
3210 Eagle Run Dr Suite 200 Grand Rapids MI 49525
Phone: (616) 957-1200
Fax: (616) 957-1297
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 6802067415 Michigan
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 6802067415 Michigan
Behavioral Health & Social Service Providers / Pastoral 101YP1600X 6802067415 Michigan

Profile Details

NPI number 1275709826
LBN Legal business name Richardson, Clyde A
Credentials M DIV CAC-R
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2008
Last updated Jun 26th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275709826 NPPES
Other NONE NONE

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