Individual
DR. RANDOLPH ROBERT MACDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
1003 SALLIE LN, SHEPHERDSTOWN, WV 25443-4044
(304) 725-9645
Mailing address
PO BOX 209, SHEPHERDSTOWN, WV 25443-4044
(304) 725-9645
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
135
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0163618000
—
WV
Enumeration date
09/23/2006
Last updated
03/13/2008
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