Randolph Carey Wall, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1074 Issued in NC

Practice address

417 S Sharon Amity Rd
Charlotte, NC 28211-2875

Phone

(704) 364-0452

Fax

(704) 364-5481

NPI assigned

Feb 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 21, 2015 through Jan 21, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charlotte Psychotherapy & Consultation Group

  • Forensic Psychologist
  • Charlotte, NC
  • NPI 1821027988

  Clinical

  NPD (past)
• Deitchman Associates

  • Clinical Psychologist
  • Charlotte, NC
  • NPI 1427081793
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1659345163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 S SHARON AMITY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112875",
            "telephone_number": "704-364-0452",
            "fax_number": "704-364-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S SHARON AMITY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112875",
            "telephone_number": "704-364-0452",
            "fax_number": "704-364-5481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "RANDOLPH",
        "middle_name": "CAREY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Bryan Wall, DMD
• Kelli Anne Wall
• Kelli Maureen Wall, FNP-C
• Mary Angela Wall, SLP
• Michael Wall
• Debbie Ann Wallace-Pratt, LCSWA
• Alysen Janae Wallace, MS, LPCA
• Andrea Nicole Wallace, FNP
• Anna Odessa Wallace
• Anya Wallace, PA-C

• Clinical Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.