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1801223110
KENNY WADE RICHARDSON
OMAHA, NE
NPI
1801223110
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NE 396)
Enumeration Date
2013-10-01
Last Update Date
2013-10-01
Business Address
-- KENNY WADE RICHARDSON LADC
130 N 39TH ST
OMAHA, NE 68131-2307
Phone number: 402-558-7088
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Mailing Address
-- KENNY WADE RICHARDSON LADC
130 N 39TH ST
OMAHA, NE 68131-2307
Phone number: 402-558-7088
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