Individual
MR. RANDALL PAUL WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LCSW 3920
Contact information
Practice address
101 LENA DRIVE, HAWKINS CN MENTAL HEALTH CTR, ROGERSVILLE, TN 37857
(423) 272-9239
(423) 272-1803
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3696
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW3920
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100884
ANTHEM PROF TRIGON
—
01
—
178871
ANTHEM PROF TRIGON HAWKIN
—
01
—
4076033
MAGELLAN NAVIGATOR
—
Enumeration date
08/13/2006
Last updated
07/08/2007
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