Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-15-19295 | AL |
N | 103TS0200X | School Psychologist | ||
N | 103TS0200X | School Psychologist | WXR-01058632 | AL |
NPI | 1093159451 |
---|---|
Provider Name | William Richardson |
First Address | Vestavia, AL 35216-2601 |
Second Address | Vestavia, AL 35216-2845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 28/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1588615918 | (05) | SC |