Provider Demographics
NPI:1245331446
Name:RANDOL, ELANA ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:ELLEN
Last Name:RANDOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELANA
Other - Middle Name:ELLEN
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 S GRAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4434
Mailing Address - Country:US
Mailing Address - Phone:714-480-6476
Mailing Address - Fax:714-567-7566
Practice Address - Street 1:1300 S GRAND AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4434
Practice Address - Country:US
Practice Address - Phone:714-480-6476
Practice Address - Fax:714-567-7566
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW689101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical