Individual
MR. DOUGLASS RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPSY, CADC III
Contact information
Practice address
620 N AURORA ST STE 1, STOCKTON, CA 95202-2276
(209) 468-9370
Mailing address
12935 ALCOSTA BLVD UNIT 3882, SAN RAMON, CA 94583-6181
(209) 696-1125
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
BII00640223
CA
172V00000X
Community Health Worker
BII00640223
CA
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
BII00640223
CA
Other
Enumeration date
12/05/2018
Last updated
04/02/2025
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