Provider Demographics
NPI:1720201742
Name:RANDALL, DARIUS LAMONT (LMSW)
Entity type:Individual
Prefix:MR
First Name:DARIUS
Middle Name:LAMONT
Last Name:RANDALL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9578 SNOW VALLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-8989
Mailing Address - Country:US
Mailing Address - Phone:616-287-5331
Mailing Address - Fax:616-469-1124
Practice Address - Street 1:4500 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3665
Practice Address - Country:US
Practice Address - Phone:616-443-4121
Practice Address - Fax:616-469-1124
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1720201742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health