Healthcare Provider Details

I. General information

NPI: 1528979598
Provider Name (Legal Business Name): RANDA DENNISTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RANDA GADBURY

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 W PIERCE ST
CARLSBAD NM
88220-3514
US

IV. Provider business mailing address

PO BOX 3141
CARLSBAD NM
88221-3141
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5552
  • Fax: 575-725-5552
Mailing address:
  • Phone: 575-725-5552
  • Fax: 575-725-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0807
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: