Provider Demographics
NPI:1861378820
Name:RANDOLPH, DARRYL
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 LEEWARD WAY
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2856
Mailing Address - Country:US
Mailing Address - Phone:850-902-0583
Mailing Address - Fax:
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 3B
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5253
Practice Address - Country:US
Practice Address - Phone:850-862-3772
Practice Address - Fax:850-974-4385
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist