Individual
MR. THURSTON RANDALL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
250 GRAND CONCOURSE, BRONX, NY 10451
(718) 292-2240
Mailing address
31 LEONARD ST. SUITE 19Q, BROOKLYN, NY 11206
(347) 863-9001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21943
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21943
—
NY
Enumeration date
09/20/2017
Last updated
09/20/2017
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