Individual
MICHAEL JOHN RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
3747P1801X
Contact information
Practice address
1109 MEAD RD, BELLBROOK, OH 45305-8747
(937) 973-9199
Mailing address
387 1/2 W 5TH ST, CHILLICOTHE, OH 45601-3034
(937) 397-3919
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCII.161340
OH
3747P1801X
Personal Care Attendant
Primary
0441283
OH
Other
Enumeration date
08/30/2017
Last updated
05/10/2021
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