Provider Demographics
NPI:1598392847
Name:RANDLEMAN, SHAUNDA RAE (LCMHC)
Entity Type:Individual
Prefix:
First Name:SHAUNDA
Middle Name:RAE
Last Name:RANDLEMAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8621 HOLLOW CREEK CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-7515
Mailing Address - Country:US
Mailing Address - Phone:336-466-0001
Mailing Address - Fax:
Practice Address - Street 1:1611 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2411
Practice Address - Country:US
Practice Address - Phone:704-970-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15271101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor