Provider Demographics
NPI:1235323163
Name:REDMAN, JENNIFER EILEEN (LPC, LCAS, LCADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EILEEN
Last Name:REDMAN
Suffix:
Gender:F
Credentials:LPC, LCAS, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SHIPYARD BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6192
Mailing Address - Country:US
Mailing Address - Phone:910-763-3166
Mailing Address - Fax:910-763-3169
Practice Address - Street 1:4000 SHIPYARD BLVD
Practice Address - Street 2:STE 130
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6192
Practice Address - Country:US
Practice Address - Phone:910-763-3166
Practice Address - Fax:910-763-3169
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA463101YA0400X
NC7250101YM0800X
NCLCAS 205439101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)