Provider Demographics
NPI:1518327618
Name:RANDALL, WILLIAM IV (LMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:RANDALL
Suffix:IV
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HIGHLAND AVE UNIT 121
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7082
Mailing Address - Country:US
Mailing Address - Phone:619-855-2429
Mailing Address - Fax:
Practice Address - Street 1:336 OXFORD ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3120
Practice Address - Country:US
Practice Address - Phone:619-855-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2023-07-12
Deactivation Date:2019-12-21
Deactivation Code:
Reactivation Date:2019-12-27
Provider Licenses
StateLicense IDTaxonomies
CA139589106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program