Individual
ILENE ANN RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
15262 RUSSELL DR, ONANCOCK, VA 23417-3004
(410) 713-0709
(410) 546-0264
Mailing address
15262 RUSSELL DR, ONANCOCK, VA 23417-3004
(410) 713-0709
(410) 546-0264
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC1278
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
412815000
STATE OF MARYLAND
MD
01
—
7452697
AETNA
MD
01
—
805688000
MAGELLAN
MD
Enumeration date
09/27/2005
Last updated
01/10/2016
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