Individual
MARK HAMPTON RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC, CSIT, LADC
Contact information
Practice address
405 STAGELINE RD, HUDSON, WI 54016-1793
(715) 531-6210
(715) 531-6755
Mailing address
405 STAGELINE RD, HUDSON, WI 54016-1793
(715) 531-6210
(715) 531-6766
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16008-132
WI
Other
Enumeration date
10/03/2023
Last updated
10/03/2023
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