Provider Demographics
NPI:1154585917
Name:STINE, RANDY MARC (BS, CADC, ADSAC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:MARC
Last Name:STINE
Suffix:
Gender:M
Credentials:BS, CADC, ADSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 US HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-4229
Mailing Address - Country:US
Mailing Address - Phone:918-787-2242
Mailing Address - Fax:918-786-5985
Practice Address - Street 1:32300 S 625 RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74345-1585
Practice Address - Country:US
Practice Address - Phone:918-787-2242
Practice Address - Fax:918-786-5985
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)