Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Clyde A Richardson, MDIVCAC-R

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1275709826

Clyde A Richardson, MDIVCAC-R is an Addiction (Substance Use Disorder) Counselor in Grand Rapids, Michigan. Licensed in Michigan. Registered with an NPI since 2008.

Licensed in
MI
In the registry since
2008
Specialties on file
3
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Practice location Address checks out

3210 Eagle Run Dr Ste 200
Grand Rapids, MI 49525
Phone: (616) 957-1200
Fax: (616) 957-1297
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 6802067415 (MI)
Mental Health Counselor Taxonomy 101YM0800X · Licence 6802067415 (MI)
Pastoral Counselor Taxonomy 101YP1600X · Licence 6802067415 (MI)

Record details

NPI number1275709826
Entity typeIndividual (Type 1)
GenderMale
Credentials MDIVCAC-R
Sole proprietorNo
NPI enumeratedMay 5, 2008
Last updated in NPPESJune 26, 2009

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