MEDICARE: MS. CHRISTINE RANDOLPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	918	CA
2	101YP2500X	Professional Counselor	918	CA

General Provider Information

NPI Number	:	1235714155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE RANDOLPH

Provider Business Mailing Address
First Line	:	2750 MCALLISTER ST APT 203
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4125
Country	:	US
Telephone Number	:	415-793-5637
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 MCALLISTER ST APT 203
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4125
Country	:	US
Telephone Number	:	415-793-5637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	04/12/2022

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