Active NPI
Marina Lynn Randles, LCMHCA
- Mental Health Counselor
- Davidson, NC
National Provider Identifier
1407481435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A14662
- Practice address
- 452 S Main St Ste H
Davidson, NC 28036-7058 - Phone
- (704) 651-9851
- NPI assigned
- Mar 10, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A14662 | NC | Primary |
Addresses
Primary practice location
452 S Main St Ste H
Davidson, NC 28036-7058
Mailing address
291 Bridges Farm Rd
Mooresville, NC 28115-8757
Phone (704) 651-9851
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 12, 2024 through Apr 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A14662 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584057600000",
"number": "1407481435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "291 BRIDGES FARM RD",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281158757",
"telephone_number": "704-651-9851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "452 S MAIN ST STE H",
"city": "DAVIDSON",
"state": "NC",
"postal_code": "280367058",
"telephone_number": "704-651-9851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDLES",
"first_name": "MARINA",
"middle_name": "LYNN",
"credential": "LCMHCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-10",
"last_updated": "2020-03-13",
"certification_date": "2020-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A14662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davidson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.