Healthcare Provider Details

I. General information

NPI: 1285871855
Provider Name (Legal Business Name): RANDOLPH SCOTT HOLLINGSWORTH LPC/:ISAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 SPURLOCK AVE
HOLBROOK AZ
86025-1960
US

IV. Provider business mailing address

1305 SPURLOCK AVE
HOLBROOK AZ
86025-1960
US

V. Phone/Fax

Practice location:
  • Phone: 520-249-8428
  • Fax:
Mailing address:
  • Phone: 520-249-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-10504
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC -12687
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: