Provider Demographics
NPI:1609670116
Name:RANDLEMAN, MORGAN
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:RANDLEMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 BANNINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1341
Mailing Address - Country:US
Mailing Address - Phone:704-705-8706
Mailing Address - Fax:
Practice Address - Street 1:6419 BANNINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1341
Practice Address - Country:US
Practice Address - Phone:704-533-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health