Individual
KEVIN J RICHARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
199 FRASIER ST SE, MARIETTA, GA 30060-2201
(678) 310-3442
(678) 564-4401
Mailing address
199 FRASIER ST SE, MARIETTA, GA 30060-2201
(678) 310-3442
(678) 564-4401
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY002508
GA
103TF0200X
Forensic Psychologist
Primary
PSY002508
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000950441A
—
GA
Enumeration date
10/02/2006
Last updated
06/29/2011
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