Healthcare Provider Details

I. General information

NPI: 1770434276
Provider Name (Legal Business Name): TIFFANIE RANDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S DUNCAN BYP STE B
UNION SC
29379-7830
US

IV. Provider business mailing address

8024 TRICIAPOINTE PL
INDIAN LAND SC
29707-0189
US

V. Phone/Fax

Practice location:
  • Phone: 864-214-4606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10753
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: