Provider Demographics
NPI:1295233161
Name:RANDALL, NATASHA LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:LYNN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1033 BAKERSFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-2783
Mailing Address - Country:US
Mailing Address - Phone:202-327-3613
Mailing Address - Fax:
Practice Address - Street 1:600 JACKSON ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5719
Practice Address - Country:US
Practice Address - Phone:540-373-3223
Practice Address - Fax:540-371-3753
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040112161041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator