Individual
MR. JEFFREY DWAYNE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPC
Contact information
Practice address
501 HIGHWAY 90 E, LITTLE RIVER, SC 29566-9261
(803) 422-7231
Mailing address
501 HIGHWAY 90 E, LITTLE RIVER, SC 29566
(803) 422-7231
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421504
—
SC
Enumeration date
02/21/2007
Last updated
09/18/2014
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