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General NPI Number Information
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NPI Number | 1124748058
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Entity Type | Individual
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Provider Name | ADRIENNE RANDALL RIC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 2510 HUNTER PL STE 101
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City | WOODBRIDGE
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State | VA
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Zip | 22192-3938
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Country | US
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Telephone | 202-805-2168
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 FIELDING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22309-1318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704014946
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License Number State | VA
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