Individual
RANDALL EDWARD SURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1200 N WEST AVE, JACKSON, MI 49202-2179
(517) 789-1200
(517) 789-1276
Mailing address
1200 N WEST AVE, JACKSON, MI 49202-2179
(517) 789-1200
(517) 789-1276
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401016161
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401016161
STATE LICENSE
MI
Enumeration date
10/19/2018
Last updated
10/30/2024
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