Provider Demographics
NPI:1053401364
Name:O'TOOLE, RANDALL CHRISTOPHER (LCSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:CHRISTOPHER
Last Name:O'TOOLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 TUNLAW RD NW APT 518
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4814
Mailing Address - Country:US
Mailing Address - Phone:703-901-8681
Mailing Address - Fax:703-425-9200
Practice Address - Street 1:8000 FORBES PL
Practice Address - Street 2:SUITE #210
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2200
Practice Address - Country:US
Practice Address - Phone:703-425-9200
Practice Address - Fax:703-425-9206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical