Provider Demographics
NPI:1245625193
Name:RANDALL COUNSELING AND THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:RANDALL COUNSELING AND THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VENITA
Authorized Official - Middle Name:CATRICE
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-561-1913
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29597-0924
Mailing Address - Country:US
Mailing Address - Phone:803-701-9693
Mailing Address - Fax:
Practice Address - Street 1:1019 HIGHWAY 17 S
Practice Address - Street 2:SUITE 109
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3702
Practice Address - Country:US
Practice Address - Phone:803-701-9693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health