Provider Demographics
NPI:1275054413
Name:RANDLE, MEREDITH HOLLY (MDIV, LPC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:HOLLY
Last Name:RANDLE
Suffix:
Gender:F
Credentials:MDIV, LPC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:RANDLE
Other - Last Name:SPIARS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDIV, LPC
Mailing Address - Street 1:2223 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2237
Mailing Address - Country:US
Mailing Address - Phone:864-933-9642
Mailing Address - Fax:
Practice Address - Street 1:218 TRIBBLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-4339
Practice Address - Country:US
Practice Address - Phone:864-642-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6026101Y00000X
SC6674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor