Provider Demographics
NPI:1093392904
Name:RANDALL, ORREY JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ORREY
Middle Name:JOSEPH
Last Name:RANDALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2609
Mailing Address - Country:US
Mailing Address - Phone:540-727-0770
Mailing Address - Fax:540-727-0770
Practice Address - Street 1:605 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2609
Practice Address - Country:US
Practice Address - Phone:540-727-0770
Practice Address - Fax:540-727-0770
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904012719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904012719Medicaid