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General NPI Number Information
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NPI Number | 1568526085
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Entity Type | Individual
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Provider Name | RANDOLPH GRAY PERRYMAN M.ED.,LPC
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 301 SOUTH ELM ST.
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City | GREENSBORO
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State | NC
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Zip | 27401-2696
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Country | US
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Telephone | 336-883-7480
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Fax | 336-883-4015
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Provider Business Mailing Address
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Address Line | 1263 HARVEY TEAGUE RD
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City | WINSTON SALEM
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State | NC
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Zip | 27107-9247
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Country | US
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Telephone | 336-769-1661
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4208
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License Number State | NC
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