Provider Demographics
NPI:1235406109
Name:REDLAK RECOVERY CENTER, PLLC
Entity Type:Organization
Organization Name:REDLAK RECOVERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:SABINA
Authorized Official - Last Name:REDLAK-OLCESE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:704-654-9760
Mailing Address - Street 1:3421 TWELVE OAKS PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-4432
Mailing Address - Country:US
Mailing Address - Phone:704-654-9760
Mailing Address - Fax:704-552-3705
Practice Address - Street 1:10801 JOHNSTON RD STE 217
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7856
Practice Address - Country:US
Practice Address - Phone:704-654-9760
Practice Address - Fax:704-552-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty