Diana Randolph, LICSW, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

DP00941263 Issued in WV

Practice address

715 Main St
Point Pleasant, WV 25550-1226

Phone

(304) 675-2371

Fax

(304) 399-3700

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384128000000",
    "number": "1578675658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 MAIN ST",
            "city": "POINT PLEASANT",
            "state": "WV",
            "postal_code": "255501226",
            "telephone_number": "304-675-2371",
            "fax_number": "304-399-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 MAIN ST",
            "city": "POINT PLEASANT",
            "state": "WV",
            "postal_code": "255501226",
            "telephone_number": "304-675-2371",
            "fax_number": "304-399-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "DIANA",
        "credential": "LICSW, LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I10213",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "DP00941263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005355002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Point Imaging Consultants Inc
• Bridget Sue Porter
• Jessica Joyce Queen, LGSW
• R.a Hanna, DDS Inc.
• Hamilton Keith Rake
• Kelly Randolph
• Taylor Ratliff
• Charlotte Elisha Reed, FNP-BC
• Christina Marie Rehn
• Diana Lynn Riddle, BC-FNP

• Clinical Social Worker in Point Pleasant, WV
• Providers in Point Pleasant, WV by specialty
• Clinical Social Worker in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.