Individual
KATHY RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
284 CUMBERLAND AVE, PORTLAND, ME 04101-4927
(207) 874-8250
Mailing address
284 CUMBERLAND AVE, PORTLAND, ME 04101-4927
(207) 874-8250
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LS870
ME
Other
Enumeration date
04/15/2011
Last updated
04/15/2011
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