Individual
DIANA RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW, LISW
Contact information
Practice address
715 MAIN ST, POINT PLEASANT, WV 25550-1226
(304) 675-2371
(304) 399-3700
Mailing address
715 MAIN ST, POINT PLEASANT, WV 25550-1226
(304) 675-2371
(304) 399-3700
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
I10213
OH
1041C0700X
Clinical Social Worker
Primary
DP00941263
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005355002
—
WV
Enumeration date
08/31/2006
Last updated
11/11/2013
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