Provider Demographics
NPI:1376371682
Name:CATHERINE RANDALL, PHD, LCSW LLC
Entity type:Organization
Organization Name:CATHERINE RANDALL, PHD, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-833-8688
Mailing Address - Street 1:2724 BROKENBACK LN
Mailing Address - Street 2:
Mailing Address - City:DYKE
Mailing Address - State:VA
Mailing Address - Zip Code:22935-1014
Mailing Address - Country:US
Mailing Address - Phone:813-833-8688
Mailing Address - Fax:
Practice Address - Street 1:224 CARLTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5972
Practice Address - Country:US
Practice Address - Phone:813-833-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty