Provider Demographics
NPI:1568042869
Name:RANDOLPH, TONYA LEWIS (M ED, LPC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LEWIS
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-2436
Mailing Address - Country:US
Mailing Address - Phone:985-514-1739
Mailing Address - Fax:
Practice Address - Street 1:308 AVENUE C
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-2436
Practice Address - Country:US
Practice Address - Phone:985-514-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA491149101YS0200X
LA5205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool