Individual
IDA JOYCE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2860 S CIRCLE DR STE 220, COLORADO SPRINGS, CO 80906-4133
(719) 634-1240
(719) 540-0174
Mailing address
2860 S CIRCLE DR STE 220, COLORADO SPRINGS, CO 80906-4133
(719) 634-1240
(719) 540-0174
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1745-01
CO
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
07/17/2009
Last updated
01/31/2020
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