Provider Demographics
NPI:1003326653
Name:CABLE, RANDY WAYNE II (LSW, LCDCIII)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:WAYNE
Last Name:CABLE
Suffix:II
Gender:M
Credentials:LSW, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1403
Mailing Address - Country:US
Mailing Address - Phone:740-237-4981
Mailing Address - Fax:
Practice Address - Street 1:117 N 4TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1403
Practice Address - Country:US
Practice Address - Phone:740-237-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162366101YA0400X
OHQMHS101YM0800X
171M00000X
OHAPS.003697175T00000X
OHS.22077323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH161374Medicaid