Basic Information
| Provider Information | |||||||||
| NPI: | 1699160036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAFOND | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICDC-CS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 COUNTRY CLUB DR | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434021603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193088940 | ||||||||
| FaxNumber: | 4196910601 | ||||||||
| Practice Location | |||||||||
| Address1: | 732 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436052338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196910600 | ||||||||
| FaxNumber: | 4196910601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 902328 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.