Provider Demographics
NPI:1629761911
Name:RANDOLPH, KOBE BRANDON
Entity Type:Individual
Prefix:
First Name:KOBE
Middle Name:BRANDON
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GREENLAWN DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9498
Mailing Address - Country:US
Mailing Address - Phone:336-528-2317
Mailing Address - Fax:
Practice Address - Street 1:217 GREENLAWN DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9498
Practice Address - Country:US
Practice Address - Phone:336-528-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker