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General NPI Number Information
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NPI Number | 1619227824
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Entity Type | Organization
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Legal Business Name | RANDY SMIES, PH.D. LLC
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 1744 SAM RITTENBERG BLVD SUITE A3
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City | CHARLESTON
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State | SC
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Zip | 29407-4935
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Country | US
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Telephone | 843-437-1931
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Fax | 843-852-2239
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Provider Business Mailing Address
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Address Line | 1744 SAM RITTENBERG BLVD SUITE A3
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City | CHARLESTON
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State | SC
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Zip | 29407-4935
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Country | US
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Telephone | 843-437-1931
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Fax | 843-852-2239
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. RANDALL JOHN SMIES
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Credential | PH.D.
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Telephone | 843-437-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1054
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License Number State | SC
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