Provider Demographics
NPI:1750539011
Name:RANDOLPH, LUTRICIA ANN
Entity type:Individual
Prefix:MS
First Name:LUTRICIA
Middle Name:ANN
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:7 AMELIA WAY
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-0032
Mailing Address - Country:US
Mailing Address - Phone:510-472-2852
Mailing Address - Fax:
Practice Address - Street 1:3024 WILLOW PASS RD
Practice Address - Street 2:3024 WILLOW PASS ROAD
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2588
Practice Address - Country:US
Practice Address - Phone:925-363-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)