Healthcare Provider Details

I. General information

NPI: 1386177673
Provider Name (Legal Business Name): ALYNDA RANDOLPH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date: 06/28/2018
Reactivation Date: 11/22/2022

III. Provider practice location address

1234 3RD AVE S
BIRMINGHAM AL
35233-1311
US

IV. Provider business mailing address

8168 ELLIOTT RD STE 1
EASTON MD
21601-7111
US

V. Phone/Fax

Practice location:
  • Phone: 205-202-1151
  • Fax:
Mailing address:
  • Phone: 205-202-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07006
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004374
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: