Basic Information
| Provider Information | |||||||||
| NPI: | 1023566247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | ROSA | ||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2809 FOREST HOME RD | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724015320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669721268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4001 COMMERCIAL CENTER DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723649616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707327920 | ||||||||
| FaxNumber: | 8707327923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2016 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A2108030 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.