Provider Demographics
NPI:1780247965
Name:RANDALL, CHARONNE MONIIQUE (LCSW-C)
Entity type:Individual
Prefix:
First Name:CHARONNE
Middle Name:MONIIQUE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 PELHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1070
Mailing Address - Country:US
Mailing Address - Phone:443-986-1378
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 198
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5339
Practice Address - Country:US
Practice Address - Phone:301-386-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD153571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical