Provider Demographics
NPI:1699927442
Name:VORHEES, RANDALL FIELDER (LSMSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:FIELDER
Last Name:VORHEES
Suffix:
Gender:M
Credentials:LSMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MERRIWEATHER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3533
Mailing Address - Country:US
Mailing Address - Phone:313-516-3998
Mailing Address - Fax:
Practice Address - Street 1:209 MERRIWEATHER RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3533
Practice Address - Country:US
Practice Address - Phone:313-516-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010157691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0892961OtherBCBSM PIN
MI1891961116Medicare PIN
MION18180Medicare PIN