Provider Demographics
NPI:1205020369
Name:PUMPHREY, RANDY W (DMIN, LPC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:W
Last Name:PUMPHREY
Suffix:
Gender:M
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 14TH ST. NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3633
Mailing Address - Country:US
Mailing Address - Phone:202-939-7679
Mailing Address - Fax:202-939-7655
Practice Address - Street 1:1701 14TH ST. NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3633
Practice Address - Country:US
Practice Address - Phone:202-939-7679
Practice Address - Fax:202-939-7655
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC1134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional