MEDICARE: RANDY WAYNE CABLE II LISW, LICDC, PRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	APS.003697	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162366	OH
3	101YM0800X	Mental Health Counselor	QMHS	OH
4	171M00000X	Case Manager/Care Coordinator
5	1041C0700X	Clinical Social Worker	I.2405356	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003326653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY WAYNE CABLE II LISW, LICDC, PRS

Provider Business Mailing Address
First Line	:	186 STANLEY ST
Second Line	:
City	:	COAL GROVE
State	:	OH
Zip	:	45638-3148
Country	:	US
Telephone Number	:	740-237-4981
Fax Number	:	877-325-2816

Provider Business Practice Location Address
First Line	:	323 MARION PIKE STE 1
Second Line	:
City	:	COAL GROVE
State	:	OH
Zip	:	45638-2958
Country	:	US
Telephone Number	:	740-237-4981
Fax Number	:	877-325-2816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	02/25/2026

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Directions to “ RANDY WAYNE CABLE II LISW, LICDC, PRS” Practice Location

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