Provider Demographics
NPI:1285014746
Name:LUSTER, RANDALL (NCAC II, CSAC, SAP)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:LUSTER
Suffix:
Gender:M
Credentials:NCAC II, CSAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 RIO RD W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1362
Mailing Address - Country:US
Mailing Address - Phone:434-282-2294
Mailing Address - Fax:434-282-2644
Practice Address - Street 1:355 RIO RD W
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1362
Practice Address - Country:US
Practice Address - Phone:434-282-2294
Practice Address - Fax:434-282-2644
Is Sole Proprietor?:No
Enumeration Date:2015-05-31
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)