Individual
MRS. MERINDA DOREEN RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SERVICE FACIL
Contact information
Practice address
5113 S JESSUP RD, CHESTERFIELD, VA 23832-8238
(804) 908-7687
(888) 745-0938
Mailing address
5113 S JESSUP RD, CHESTERFIELD, VA 23832-8238
(804) 908-7687
(888) 745-0938
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
471373561
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0173936938
—
VA
Enumeration date
06/24/2015
Last updated
06/24/2015
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