Provider Demographics
NPI:1104278241
Name:RANDOLPH-GREENE, ELIZABETH CHRISTINE (MS, LCPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINE
Last Name:RANDOLPH-GREENE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CHRISTINE
Other - Last Name:RANDOLPH-GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LCPC, LCADC
Mailing Address - Street 1:1082 DAVOL ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1124
Mailing Address - Country:US
Mailing Address - Phone:508-678-2833
Mailing Address - Fax:
Practice Address - Street 1:4773 CAUGHLIN PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-1011
Practice Address - Country:US
Practice Address - Phone:775-221-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01670-L101YA0400X
NVCP5880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)