Carlos De'Wayne Richardson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3843 Issued in AL

Practice address

100 Century Park S Ste 102
Birmingham, AL 35226-3922

Phone

(205) 565-6554

Fax

(888) 386-9624

NPI assigned

Sep 11, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547424000000",
    "number": "1083133003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CENTURY PARK S STE 102",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352263922",
            "telephone_number": "205-565-6554",
            "fax_number": "888-386-9624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CENTURY PARK S STE 102",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352263922",
            "telephone_number": "205-565-6554",
            "fax_number": "888-386-9624"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "156 Mayfair Ln",
            "address_purpose": "LOCATION",
            "city": "Calera",
            "state": "AL",
            "postal_code": "350405598",
            "country_code": "US",
            "telephone_number": "205-306-2866",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4204 Edmonton Dr",
            "address_purpose": "LOCATION",
            "city": "Bessemer",
            "state": "AL",
            "postal_code": "350224878",
            "country_code": "US",
            "telephone_number": "205-425-1200 x4353",
            "fax_number": "205-425-9606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "CARLOS",
        "middle_name": "DE'WAYNE",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-11",
        "last_updated": "2019-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AL",
            "license": "C2131A",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AL",
            "license": "3843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46--1731139",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "46-1731139",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richardson Rehabilitation Services, PC
• Richardson-Mintzcounseling Center
• Alzelda Richardson, PH.D.
• Brock Richardson, MD
• Caleb Daniel Richardson, CRNA
• Claire Richardson
• Colin Joseph Richardson
• Devona Richardson
• Dexter Richardson, RBT
• Elizabeth Joy Richardson, PHD

• Professional Counselor in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Professional Counselor in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.