Healthcare Provider Details

I. General information

NPI: 1700795218
Provider Name (Legal Business Name): RANDALL THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 N LINWOOD AVE
BALTIMORE MD
21205-1324
US

IV. Provider business mailing address

912 N LINWOOD AVE
BALTIMORE MD
21205-1324
US

V. Phone/Fax

Practice location:
  • Phone: 443-522-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREA NICOLE RANDALL
Title or Position: CEO
Credential:
Phone: 443-929-0062