Provider Demographics
NPI:1205057031
Name:OVERDORFF, RANDALL L (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:L
Last Name:OVERDORFF
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 PINE TREE CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1334
Mailing Address - Country:US
Mailing Address - Phone:770-535-8088
Mailing Address - Fax:770-718-5531
Practice Address - Street 1:2038 PINE TREE CIR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1334
Practice Address - Country:US
Practice Address - Phone:678-936-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1347101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA359454386AMedicaid