Provider Demographics
NPI:1104175140
Name:RANDLE, NEASA (LCSW)
Entity type:Individual
Prefix:
First Name:NEASA
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2818
Mailing Address - Country:US
Mailing Address - Phone:757-644-6391
Mailing Address - Fax:757-622-2011
Practice Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2818
Practice Address - Country:US
Practice Address - Phone:757-644-6391
Practice Address - Fax:757-622-2011
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid