| Doctor Name: | RANDY MARC STINE |
| NPI Number: | 1154585917 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BS, CADC, ADSAC |
| License Number: | |
| Business Practice Address: | 32300 S 625 Rd Grove, OK - 743451585 |
| Business Phone Number: | 9187872242 |
| Business Fax Number: | 9187865985 |
| Mailing Address: | 4602 Us Highway 59 N, GROVE |
| State: | OK |
| Postal Code: | 743444229 |
| Phone Number: | 9187872242 |
| Fax Number: | 9187865985 |
| NPI Enumeration Date: | 07/10/2008 |
| NPI Last Update Date: | 03/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |