Provider Demographics
NPI:1619227824
Name:RANDY SMIES, PH.D. LLC
Entity Type:Organization
Organization Name:RANDY SMIES, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SMIES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-437-1931
Mailing Address - Street 1:1744 SAM RITTENBERG BLVD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4935
Mailing Address - Country:US
Mailing Address - Phone:843-437-1931
Mailing Address - Fax:843-852-2239
Practice Address - Street 1:1744 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE A3
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4935
Practice Address - Country:US
Practice Address - Phone:843-437-1931
Practice Address - Fax:843-852-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty