Provider Demographics
NPI:1326270117
Name:SIMPSON, RANDY C (MASTERS IN PROFESSIO)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:C
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MASTERS IN PROFESSIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 ST. MATTHEWS ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-3219
Mailing Address - Country:US
Mailing Address - Phone:803-536-1571
Mailing Address - Fax:803-536-1463
Practice Address - Street 1:2319 ST. MATTHEWS ROAD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-3219
Practice Address - Country:US
Practice Address - Phone:803-536-1571
Practice Address - Fax:803-536-1463
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC413093Medicaid