Provider Demographics
NPI:1285091264
Name:RANDOLPH, MICHELLE (LPC, LBSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:LPC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3223
Mailing Address - Street 2:2014 UPPER WETUMPKA ROAD
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-0223
Mailing Address - Country:US
Mailing Address - Phone:334-279-7830
Mailing Address - Fax:334-277-8862
Practice Address - Street 1:2361 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1633
Practice Address - Country:US
Practice Address - Phone:334-279-7830
Practice Address - Fax:334-277-8862
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3477101YP2500X
AL1688B104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker