Provider Demographics
NPI:1750503942
Name:RANDALL, FRANK AUSTIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:AUSTIN
Last Name:RANDALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 WALNUT RDG # 4344
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30536-2608
Mailing Address - Country:US
Mailing Address - Phone:770-590-3736
Mailing Address - Fax:
Practice Address - Street 1:64 SAILORS DR STE 114
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3744
Practice Address - Country:US
Practice Address - Phone:770-590-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional