Provider Demographics
NPI:1689414898
Name:RICHARDSON, CALI
Entity type:Individual
Prefix:
First Name:CALI
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 EASTWOOD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1873
Mailing Address - Country:US
Mailing Address - Phone:346-500-5842
Mailing Address - Fax:346-500-5842
Practice Address - Street 1:432 EASTWOOD RD STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1873
Practice Address - Country:US
Practice Address - Phone:346-500-5842
Practice Address - Fax:346-500-5842
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician