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General NPI Number Information
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NPI Number | 1548656622
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Entity Type | Individual
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Provider Name | RANDAL WAYNE WITHERS NCC LCMHC LCAS
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Gender | Male
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 715 FAIRGROVE CHURCH RD SE STE 202
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City | CONOVER
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State | NC
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Zip | 28613-9289
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Country | US
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Telephone | 828-201-2778
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Fax | 828-282-0899
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Provider Business Mailing Address
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Address Line | 104 N GREEN ST UNIT 148
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City | MORGANTON
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State | NC
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Zip | 28655-3422
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Country | US
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Telephone | 282-012-7788
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Fax | 828-282-0899
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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 | 11110
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License Number State | NC
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