Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | MA | |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MA | |
Y | 101YM0800X | Mental Health Counselor | MA | |
N | 101YP1600X | Pastoral Counselor | MA | |
N | 101YP2500X | Professional Counselor | MA |
NPI | 1205129988 |
---|---|
Provider Name | Mr. Randall L Richard |
First Address | Weston, MA 02493-2716 |
Second Address | Brockton, MA 02301-7501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2011 |
Last Update Date | 27/05/2011 |