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General NPI Number Information
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NPI Number | 1841088507
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Entity Type | Individual
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Provider Name | NASIR I RANDOLPH MSW, LCSWA
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Gender | Male
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 301 MCCULLOUGH DR STE 520
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City | CHARLOTTE
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State | NC
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Zip | 28262-1336
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Country | US
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Telephone | 980-286-4943
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Fax |
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Provider Business Mailing Address
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Address Line | 574 TROTTERS LN
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City | MONCKS CORNER
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State | SC
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Zip | 29461-6740
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Country | US
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Telephone | 609-576-8382
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P022914
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License Number State | NC
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