Provider Demographics
NPI:1841388550
Name:CLIFFORD, RANDALL ALAN (LPC, LCSW)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:ALAN
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:LPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1004
Mailing Address - Country:US
Mailing Address - Phone:304-768-1401
Mailing Address - Fax:304-768-1402
Practice Address - Street 1:4501 MACCORKLE AVE SW
Practice Address - Street 2:STE 103
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1444
Practice Address - Country:US
Practice Address - Phone:304-768-1401
Practice Address - Fax:304-768-1402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV94101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health