Provider Demographics
NPI:1972650216
Name:POLLOCK, RANDOLPH ANTHONY (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:ANTHONY
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 INDIAN PAINT BRUSH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4931
Mailing Address - Country:US
Mailing Address - Phone:210-496-3343
Mailing Address - Fax:
Practice Address - Street 1:5364 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6107
Practice Address - Country:US
Practice Address - Phone:210-308-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health