Provider Demographics
NPI:1407302573
Name:RANDOLPH, CARLA (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:806 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6641
Mailing Address - Country:US
Mailing Address - Phone:804-241-2324
Mailing Address - Fax:
Practice Address - Street 1:806 N 30TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6641
Practice Address - Country:US
Practice Address - Phone:804-241-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040093941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical