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General NPI Number Information
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NPI Number | 1205057031
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Entity Type | Individual
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Provider Name | RANDALL L. OVERDORFF LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 2038 PINE TREE CIR
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City | GAINESVILLE
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State | GA
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Zip | 30501-1334
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Country | US
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Telephone | 678-936-4954
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Fax |
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Provider Business Mailing Address
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Address Line | 2038 PINE TREE CIR
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City | GAINESVILLE
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State | GA
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Zip | 30501-1334
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Country | US
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Telephone | 770-535-8088
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Fax | 770-718-5531
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1347
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License Number State | GA
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