Provider Demographics
NPI:1710614318
Name:GARLAND, RANDALL GARY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:GARY
Last Name:GARLAND
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 BROOKHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8381
Mailing Address - Country:US
Mailing Address - Phone:321-210-2813
Mailing Address - Fax:
Practice Address - Street 1:2355 TRUMAN SCARBOROUGH WAY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-1310
Practice Address - Country:US
Practice Address - Phone:321-210-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW202811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical