Provider Demographics
NPI:1467097287
Name:RANDOLPH, GALE LORRAINE (LPC)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:LORRAINE
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:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0796
Mailing Address - Country:US
Mailing Address - Phone:434-808-9291
Mailing Address - Fax:
Practice Address - Street 1:404 E 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1512
Practice Address - Country:US
Practice Address - Phone:434-808-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional