Provider Demographics
NPI:1104871748
Name:STOKES, RANDOLPH CLARKE JR (MA)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:CLARKE
Last Name:STOKES
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2418 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6480
Mailing Address - Country:US
Mailing Address - Phone:919-781-3224
Mailing Address - Fax:919-781-2626
Practice Address - Street 1:2418 BLUE RIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6480
Practice Address - Country:US
Practice Address - Phone:919-781-3224
Practice Address - Fax:919-781-2626
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional