Provider Demographics
NPI:1972784916
Name:RANDALL, VENTIA CATRICE (LPC)
Entity Type:Individual
Prefix:
First Name:VENTIA
Middle Name:CATRICE
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 436
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0436
Mailing Address - Country:US
Mailing Address - Phone:704-561-1913
Mailing Address - Fax:
Practice Address - Street 1:657 TWINFLOWER ST
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7444
Practice Address - Country:US
Practice Address - Phone:704-561-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health