Richard Fauntleroy, LICDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

976038 Issued in OH

Practice address

309 S 4TH St
Ste 222
Columbus, OH 43215-5428

Phone

(614) 221-9804

NPI assigned

Jul 12, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373587200000",
    "number": "1255772620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 S 4TH ST",
            "address_2": "STE 222",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432155428",
            "telephone_number": "614-221-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S 4TH ST",
            "address_2": "STE 222",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432155428",
            "telephone_number": "614-221-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUNTLEROY",
        "first_name": "RICHARD",
        "credential": "LICDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-12",
        "last_updated": "2013-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "976038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Columbus, OH
• Providers in Columbus, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.