Basic Information
| Provider Information | |||||||||
| NPI: | 1306987094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLAGG | ||||||||
| FirstName: | RANDALL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 S 35TH ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948043250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102344481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1175 HOWARD ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941033926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158643057 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.