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NPI Code Detail

MEDICARE: MR. RANDALL ANCIL CAMPBELL JR. LICSW, CADC, CRSS

MEDICARE: MR. RANDALL ANCIL CAMPBELL JR. LICSW, CADC, CRSS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorADC-907AL
2175T00000XPeer SpecialistCRSS-0348AL
31041C0700XClinical Social Worker4477CAL

General Provider Information

NPI Number : 1366030124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL ANCIL CAMPBELL JR. LICSW, CADC, CRSS
Provider Business Mailing Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 205-394-3765
Fax Number :
Provider Business Practice Location Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 205-394-3765
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2021
Last Update Date : 07/16/2024

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