Provider Demographics
NPI:1427709286
Name:REICHEL, RANDI (DMFT)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:
Last Name:REICHEL
Suffix:
Gender:F
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 CHARLOTTE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-7062
Mailing Address - Country:US
Mailing Address - Phone:803-701-0212
Mailing Address - Fax:
Practice Address - Street 1:4341 CHARLOTTE HWY STE 203
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-7062
Practice Address - Country:US
Practice Address - Phone:803-701-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12365A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist