Provider Demographics
NPI:1750507430
Name:RANDALL, KATHERINE G (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:G
Last Name:RANDALL
Suffix:
Gender:F
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:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-1598
Mailing Address - Country:US
Mailing Address - Phone:850-916-4901
Mailing Address - Fax:850-934-8813
Practice Address - Street 1:3880 PARADISE BAY DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-5905
Practice Address - Country:US
Practice Address - Phone:850-916-4901
Practice Address - Fax:850-934-8813
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3394101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor