Provider Demographics
NPI:1972832269
Name:KONIKOFF, RANDI (PHD LCMHCS, LCAS)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:
Last Name:KONIKOFF
Suffix:
Gender:F
Credentials:PHD LCMHCS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 BRIDGEGATE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1321
Mailing Address - Country:US
Mailing Address - Phone:704-200-1787
Mailing Address - Fax:
Practice Address - Street 1:16507A NORTHCROSS DR STE 105
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5081
Practice Address - Country:US
Practice Address - Phone:704-200-1787
Practice Address - Fax:980-276-3005
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1603101YA0400X
NC7657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)