Provider Demographics
NPI:1821181637
Name:RANDLE, WILLIAM (LISW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RANDLE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:BLDG N
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3192
Mailing Address - Country:US
Mailing Address - Phone:614-293-9550
Mailing Address - Fax:614-293-9549
Practice Address - Street 1:500 E OLIVE AVE STE 240
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2171
Practice Address - Country:US
Practice Address - Phone:614-293-9550
Practice Address - Fax:614-293-9549
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI102451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRASW30621Medicare UPIN