Individual
MR. RANDALL ALLEN WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW, CASAC
Contact information
Practice address
126 MISSOURI AVE, MCXP-CCS-CR, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0417
(573) 596-0524
Mailing address
126 MISSOURI AVE, MCXP-CCS-CR, FORT LEONARD WOOD, MO 65473-8952
(573) 596-0417
(573) 596-0524
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
000791
MO
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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