Provider Demographics
NPI:1457552747
Name:RANDLES, LISA JEAN (MSSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:RANDLES
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:RANDLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMSW
Mailing Address - Street 1:4205 LAZARD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:413 SPRING ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3848
Practice Address - Country:US
Practice Address - Phone:423-756-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical