Provider Demographics
NPI:1396433009
Name:RANDALL, LOUIS NATHANIEL JR (LCPC)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:NATHANIEL
Last Name:RANDALL
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 CAMPFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4658
Mailing Address - Country:US
Mailing Address - Phone:443-854-3324
Mailing Address - Fax:
Practice Address - Street 1:7108 CAMPFIELD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4658
Practice Address - Country:US
Practice Address - Phone:443-854-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional