| Doctor Name: | DR. JOHN ROBERT RICHARDSON |
| NPI Number: | 1538269329 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, D.MIN. |
| License Number: | LC1087 |
| Business Practice Address: | Pp/125 Building 314 Room C106 Va Medical Center - Perry Point Div Perry Point, MD - 21902 |
| Business Phone Number: | 4106421037 |
| Business Fax Number: | 4106421843 |
| Mailing Address: | 1414 Bayview Dr, HAVRE DE GRACE |
| State: | MD |
| Postal Code: | 210782454 |
| Phone Number: | 4109393752 |
| Fax Number: | 4106421843 |
| NPI Enumeration Date: | 09/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC1087 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |