Individual
DIANA RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW, LISW
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
Update your record
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