Provider Demographics
NPI:1124801790
Name:HARRELL, RANDALL FOREHAND III (LCSWA)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:FOREHAND
Last Name:HARRELL
Suffix:III
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-4180
Mailing Address - Country:US
Mailing Address - Phone:828-848-2515
Mailing Address - Fax:
Practice Address - Street 1:395 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-4180
Practice Address - Country:US
Practice Address - Phone:828-848-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0196201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical