Randall, Tyantha G.
Randall, Tyantha G. is an sole proprietor health care provider with primary practice located at 104 Williamsport Cir Suite C, Salisbury MD 21804-6400. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Randall, Tyantha G. can be contacted via phone (443) 859-8699.Contact Information
Primary practice address
104 Williamsport Cir Suite C
Salisbury MD 21804-6400
Phone: (443) 859-8699
Fax: (443) 859-8747
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 13117 | Maryland |
Profile Details
| NPI number | 1407052400 |
|---|---|
| LBN Legal business name | Randall, Tyantha G. |
| Credentials | LCSW-C |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 26th, 2007 |
| Last updated | Feb 27th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407052400 | NPPES |
| Maryland | MEDICAID | 744800100 |
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