Provider Demographics
NPI:1144330481
Name:DIONNE, RANDY (LCPC)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:DIONNE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-3116
Mailing Address - Country:US
Mailing Address - Phone:217-585-8500
Mailing Address - Fax:217-585-8600
Practice Address - Street 1:1711 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-3116
Practice Address - Country:US
Practice Address - Phone:217-585-8500
Practice Address - Fax:217-585-8600
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health