Provider Demographics
NPI:1023295417
Name:ALDRICH, RANDALL DEAN (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:DEAN
Last Name:ALDRICH
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5349
Mailing Address - Country:US
Mailing Address - Phone:270-798-5179
Mailing Address - Fax:270-798-6075
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:CAB EBH
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-956-0620
Practice Address - Fax:270-956-0247
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1957101YA0400X
NCC005939104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)