Provider Demographics
NPI:1447780465
Name:RANDOLPH, DOREEN (LPC)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HOLMES MILL RD
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-1503
Mailing Address - Country:US
Mailing Address - Phone:609-758-2667
Mailing Address - Fax:
Practice Address - Street 1:117 HOLMES MILL RD
Practice Address - Street 2:
Practice Address - City:CREAM RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08514-1503
Practice Address - Country:US
Practice Address - Phone:609-758-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00318000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health