Provider Demographics
NPI:1174820674
Name:REDMOND, ERICA MARGARET
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARGARET
Last Name:REDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3705
Mailing Address - Country:US
Mailing Address - Phone:989-274-5522
Mailing Address - Fax:
Practice Address - Street 1:600 E BROADWAY ST
Practice Address - Street 2:STE. 200
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2701
Practice Address - Country:US
Practice Address - Phone:989-772-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional