Provider Demographics
NPI:1356773634
Name:GENOW, RANDALL E II (MSW, LMSW, CAADC)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:E
Last Name:GENOW
Suffix:II
Gender:M
Credentials:MSW, LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 HAMPTON PL STE 200
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9451
Mailing Address - Country:US
Mailing Address - Phone:989-321-4650
Mailing Address - Fax:989-321-4850
Practice Address - Street 1:5360 HAMPTON PL STE 200
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9451
Practice Address - Country:US
Practice Address - Phone:989-321-4650
Practice Address - Fax:989-321-4850
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL283307101YA0400X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health