Provider Demographics
NPI:1578163580
Name:RANDLE, CHAUNDRA (MSW, SSW)
Entity Type:Individual
Prefix:MRS
First Name:CHAUNDRA
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:MSW, SSW
Other - Prefix:MS
Other - First Name:CHAUNDRA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21951 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3702
Mailing Address - Country:US
Mailing Address - Phone:313-720-1987
Mailing Address - Fax:
Practice Address - Street 1:21951 BOULDER DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3702
Practice Address - Country:US
Practice Address - Phone:313-720-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4578245104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker