Provider Demographics
NPI:1164844858
Name:RANDALL, RONIQUE
Entity Type:Individual
Prefix:
First Name:RONIQUE
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 N CAUSEWAY BLVD STE 1232
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1746
Mailing Address - Country:US
Mailing Address - Phone:504-723-9908
Mailing Address - Fax:
Practice Address - Street 1:3900 N CAUSEWAY BLVD STE 1232
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1746
Practice Address - Country:US
Practice Address - Phone:504-723-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health