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Individual
KENNY WADE RICHARDSON
Active
Individual
KENNY WADE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
396
NE
Other
Enumeration date
10/01/2013
Last updated
10/01/2013
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