Healthcare Provider Details

I. General information

NPI: 1083239610
Provider Name (Legal Business Name): ARIANNA RANDOLPH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 10/08/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E MERCER ST STE 101
SEATTLE WA
98112-4689
US

IV. Provider business mailing address

8050 MUKILTEO SPEEDWAY #997
MUKILTEO WA
98275-1872
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-5543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60848117
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: