Provider Demographics
NPI:1285871855
Name:HOLLINGSWORTH, RANDOLPH SCOTT (LPC/:ISAC)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:SCOTT
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:LPC/:ISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SPURLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-1960
Mailing Address - Country:US
Mailing Address - Phone:520-249-8428
Mailing Address - Fax:
Practice Address - Street 1:1305 SPURLOCK AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-1960
Practice Address - Country:US
Practice Address - Phone:520-249-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC -12687101Y00000X
AZLISAC-10504101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)