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General NPI Number Information
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NPI Number | 1396659546
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Entity Type | Individual
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Provider Name | DIANNE DENISE RANDALL
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Gender | Female
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 7701 SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27615-5050
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Country | US
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Telephone | 800-701-0498
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S TRYON ST STE 2700
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City | CHARLOTTE
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State | NC
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Zip | 28280-0005
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Country | US
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Telephone | 800-701-0498
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-489357
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License Number State | NC
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