Provider Demographics
NPI:1811634207
Name:RANDALL, DAMIAN WILLIAM (LGPC)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:WILLIAM
Last Name:RANDALL
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 YORK RD STE 336
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7449
Mailing Address - Country:US
Mailing Address - Phone:443-550-7159
Mailing Address - Fax:
Practice Address - Street 1:7801 YORK RD STE 336
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7449
Practice Address - Country:US
Practice Address - Phone:443-550-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT2649101YA0400X
MDLGP15722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)