Provider Demographics
NPI:1518298736
Name:RANDALL, JEFF (PSYD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:RANDALL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NE MAYNARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9670
Mailing Address - Country:US
Mailing Address - Phone:919-466-7540
Mailing Address - Fax:919-466-7543
Practice Address - Street 1:160 NE MAYNARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-9670
Practice Address - Country:US
Practice Address - Phone:919-466-7540
Practice Address - Fax:919-466-7543
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical