Provider Demographics
NPI:1366030124
Name:CAMPBELL, RANDALL ANCIL JR (LICSW, CADC, CRSS)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:ANCIL
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:LICSW, CADC, CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W TROY ST STE B
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4455
Mailing Address - Country:US
Mailing Address - Phone:205-394-3765
Mailing Address - Fax:
Practice Address - Street 1:212 W TROY ST STE B
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4455
Practice Address - Country:US
Practice Address - Phone:205-394-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALADC-907101YA0400X
ALCRSS-0348175T00000X
AL4477C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist