Provider Demographics
NPI:1366983967
Name:RANDOLPH-MACON ACADEMY
Entity type:Organization
Organization Name:RANDOLPH-MACON ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:VS
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-636-5431
Mailing Address - Street 1:200 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2601
Mailing Address - Country:US
Mailing Address - Phone:540-636-5431
Mailing Address - Fax:540-631-3827
Practice Address - Street 1:200 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2601
Practice Address - Country:US
Practice Address - Phone:540-636-5431
Practice Address - Fax:540-631-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health