Individual
JEFFREY BLAINE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
4867 URBANA RD, SPRINGFIELD, OH 45502
(937) 971-7358
(937) 717-5995
Mailing address
4867 URBANA RD, SPRINGFIELD, OH 45502
(937) 971-7358
(937) 717-5995
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.172965
OH
Other
Enumeration date
07/09/2020
Last updated
07/11/2020
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