Healthcare Provider Details

I. General information

NPI: 1235074329
Provider Name (Legal Business Name): RANDIE ABBAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N MAIN AVE STE 100
SIOUX FALLS SD
57104-6004
US

IV. Provider business mailing address

408 S ACADEMY ST
LENNOX SD
57039-2216
US

V. Phone/Fax

Practice location:
  • Phone: 605-800-7477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24072015
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: