MEDICARE: RANDI LEE PRITCHARD

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	1041C0700X	Clinical Social Worker	P022105	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	22515	NC

General Provider Information

NPI Number	:	1104708734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI LEE PRITCHARD

Provider Business Mailing Address
First Line	:	1437 OAK HILL DR
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-8727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15720 BRIXHAM HILL AVE STE 388
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4651
Country	:	US
Telephone Number	:	980-407-7336
Fax Number	:

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

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	03/16/2026

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