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General NPI Number Information
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NPI Number | 1144590365
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Entity Type | Individual
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Provider Name | ADRIENNE ELIZABETH RANDALL-STANIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 180 W HUFFAKER LN STE 303
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City | RENO
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State | NV
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Zip | 89511-2091
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Country | US
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Telephone | 775-825-0587
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Fax |
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Provider Business Mailing Address
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Address Line | 1861 MOUNTAIN VISTA WAY
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City | RENO
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State | NV
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Zip | 89519
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Country | US
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Telephone | 702-726-0637
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7074-C
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License Number State | NV
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