Provider Demographics
NPI:1639772833
Name:RANDOLPH, PAMELA JOYCE (PHD MSPH LCDC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOYCE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PHD MSPH LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SADDLE CREEK CIR APT 1537
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3978
Mailing Address - Country:US
Mailing Address - Phone:214-414-7601
Mailing Address - Fax:
Practice Address - Street 1:1627 SADDLE CREEK CIR APT 1537
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3978
Practice Address - Country:US
Practice Address - Phone:214-414-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15495101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)