Provider Demographics
NPI:1023221744
Name:RANDLE, WILLIAM GEORGE JR (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:RANDLE
Suffix:JR
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1914
Mailing Address - Country:US
Mailing Address - Phone:314-531-1770
Mailing Address - Fax:314-381-6796
Practice Address - Street 1:4411 N NEWSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2534
Practice Address - Country:US
Practice Address - Phone:314-531-1770
Practice Address - Fax:314-381-6796
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0022071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONO.002207OtherCLINICAL SOCIAL WORKER