Provider Information for 1639840499
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RANDY RANDALL DITMORE LPC
Other Names:Other Name:JAMES RANDALL DITMORE LPCSex: Male
NPI: 1639840499
Last Updated: 2021-09-22
Certification Date: 2021-09-22
Certification Date: 2021-09-22
Details
| Name | Value | ||||||||
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| NPI | 1639840499 | ||||||||
| Enumeration Date | 2021-09-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5302 WATER TERRACE LN FULSHEAR, TX 77441-2243 United States Phone: 281-989-3908 | Fax: | ||||||||
| Primary Practice Address | 5302 WATER TERRACE LN FULSHEAR, TX 77441-2243 United States Phone: 281-989-3908 | Fax: | ||||||||
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