Individual
CLYDE A RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M DIV CAC-R
Contact information
Practice address
3210 EAGLE RUN DR, SUITE 200, GRAND RAPIDS, MI 49525
(616) 957-1200
(616) 957-1297
Mailing address
3210 EAGLE RUN DR, SUITE 200, GRAND RAPIDS, MI 49525
(616) 957-1200
(616) 957-1297
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6802067415
MI
101YM0800X
Mental Health Counselor
6802067415
MI
101YP1600X
Pastoral Counselor
6802067415
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
05/05/2008
Last updated
06/26/2009
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