Healthcare Provider Details

I. General information

NPI: 1770148116
Provider Name (Legal Business Name): RANDILYNN HUDSON CARE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RANDI LYNN BROKAW CDCA

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 04/15/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

IV. Provider business mailing address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

V. Phone/Fax

Practice location:
  • Phone: 614-844-3800
  • Fax: 614-844-6258
Mailing address:
  • Phone: 614-844-3800
  • Fax: 614-844-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.171903
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: