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General NPI Number Information
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NPI Number | 1972832269
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Entity Type | Individual
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Provider Name | RANDI KONIKOFF PH.D. LCMHCS, LCAS
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Gender | Female
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 16507A NORTHCROSS DR STE 105
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5081
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Country | US
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Telephone | 704-200-1787
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Fax | 980-276-3005
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Provider Business Mailing Address
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Address Line | 8215 BRIDGEGATE DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-1321
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Country | US
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Telephone | 704-200-1787
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1603
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7657
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License Number State | NC
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