Healthcare Provider Details

I. General information

NPI: 1205057031
Provider Name (Legal Business Name): RANDALL L. OVERDORFF LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 PINE TREE CIR
GAINESVILLE GA
30501-1334
US

IV. Provider business mailing address

2038 PINE TREE CIR
GAINESVILLE GA
30501-1334
US

V. Phone/Fax

Practice location:
  • Phone: 678-936-4954
  • Fax:
Mailing address:
  • Phone: 770-535-8088
  • Fax: 770-718-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1347
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: