| Deryck D. Richardson, Ph.d. Llc | |
|
1425 E Dublin Granville Rd Suite 204 Columbus OH 43229-3325 | |
| (614) 888-5255 | |
| (614) 888-2306 |
| Full Name | Deryck D. Richardson, Ph.d. Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1425 E Dublin Granville Rd, Columbus, Ohio |
| Authorized Official Name and Position | Deryck D'arcy Richardson (PRESIDENT) |
| Authorized Official Contact | 6148885255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Deryck D. Richardson, Ph.d. Llc 1425 E Dublin Granville Rd Suite 204 Columbus OH 43229-3325 Ph: (614) 888-5255 | Deryck D. Richardson, Ph.d. Llc 1425 E Dublin Granville Rd Suite 204 Columbus OH 43229-3325 Ph: (614) 888-5255 |
| NPI Number | 1629340914 |
|---|---|
| Provider Enumeration Date | 02/01/2012 |
| Last Update Date | 02/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629340914 | NPI | - | NPPES |
| 0453389 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 2950 (Ohio) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 2950 (Ohio) | Secondary |
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