Basic Information
Provider Information
NPI: 1003013798
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RANDALL
FirstName: KRISTIN
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: B.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 722 HILLGIRT CIR APT 4
Address2:  
City: OAKLAND
State: CA
PostalCode: 946103754
CountryCode: US
TelephoneNumber: 4153422989
FaxNumber:  
Practice Location
Address1: 1801 VICENTE ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941162923
CountryCode: US
TelephoneNumber: 4156823147
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/27/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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