Provider Demographics
NPI:1386177673
Name:RANDOLPH, ALYNDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALYNDA
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 LITTLE FLS
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5822
Mailing Address - Country:US
Mailing Address - Phone:803-393-9255
Mailing Address - Fax:
Practice Address - Street 1:1234 3RD AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1311
Practice Address - Country:US
Practice Address - Phone:205-202-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-02-16
Deactivation Date:2018-06-28
Deactivation Code:
Reactivation Date:2022-11-22
Provider Licenses
StateLicense IDTaxonomies
GAPSY004374103TC0700X
390200000X
MD07006103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program