Provider Demographics
NPI:1386196871
Name:RANDALL OVERDORFF, LPC
Entity Type:Organization
Organization Name:RANDALL OVERDORFF, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-339-7667
Mailing Address - Street 1:2038 PINE TREE CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1334
Mailing Address - Country:US
Mailing Address - Phone:678-936-4954
Mailing Address - Fax:770-534-9104
Practice Address - Street 1:629 DAWSONVILLE HWY
Practice Address - Street 2:STE 2201
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2610
Practice Address - Country:US
Practice Address - Phone:678-936-4954
Practice Address - Fax:770-534-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty