Provider Demographics
NPI:1407910789
Name:RANDOLPH, LORRAINE (MSW,SC,EL)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MSW,SC,EL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 LIVE OAK LN
Mailing Address - Street 2:P.O.BOX391,LOVEJOY,GA. 30250
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3288
Mailing Address - Country:US
Mailing Address - Phone:770-210-4699
Mailing Address - Fax:770-210-4699
Practice Address - Street 1:1762 LIVE OAK LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3288
Practice Address - Country:US
Practice Address - Phone:770-210-4699
Practice Address - Fax:770-210-4699
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker