| Doctor Name: | MS. JAYME NICOLE RANDOLPH |
| NPI Number: | 1174737159 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 6801092253 |
| Business Practice Address: | 3899 24th Ave Fort Gratiot, MI - 480594101 |
| Business Phone Number: | 8109660099 |
| Business Fax Number: | |
| Mailing Address: | 24401 Capital Blvd, CLINTON TOWNSHIP |
| State: | MI |
| Postal Code: | 480361343 |
| Phone Number: | 5867832950 |
| Fax Number: | |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 08/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801092253 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |