Randall Ancil Campbell Jr., LICSW, CADC, CRSS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4477C Issued in AL

Practice address

212 W Troy St Ste B
Dothan, AL 36303-4455

Phone

(205) 394-3765

NPI assigned

Jan 7, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifecare Wellness Counseling LLC

  • Mental Health Counselor
  • Tuscaloosa, AL
  • NPI 1851036495
  Medicare reassignment NPD
• Southeast Psychiatry Services, LLC

  • Psychiatry Physician
  • Pike Road, AL
  • NPI 1467040410
  Medicare reassignment NPD
• Houndstooth Counseling LLC

  • Clinical Social Worker
  • Tuscaloosa, AL
  • NPI 1619713682
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1366030124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W TROY ST STE B",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363034455",
            "telephone_number": "205-394-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W TROY ST STE B",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363034455",
            "telephone_number": "205-394-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "RANDALL",
        "middle_name": "ANCIL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LICSW, CADC, CRSS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-07",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AL",
            "license": "ADC-907",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "AL",
            "license": "CRSS-0348",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "4477C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shea Calhoun, CRNP
• Alexa Sophia Calvert, MS, RDN, LD
• Calvin L. Reid Geriatric Services, LLC
• Ashton Victoria Camacho
• McCayla N Campbell
• Taylor Marie Campbell, RBT
• William D Campbell, PTA
• Emily Elizabeth Cannon, M.D.
• Toni D Cannon, LPC
• Dana Capra, LPC

• Clinical Social Worker in Dothan, AL
• Providers in Dothan, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.