Provider Demographics
NPI:1275081275
Name:REDICK, EMILY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:REDICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11343 ESTANCIA VILLA CIR UNIT 4
Mailing Address - Street 2:UNIT 304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3791
Mailing Address - Country:US
Mailing Address - Phone:863-273-8930
Mailing Address - Fax:
Practice Address - Street 1:16718 N HIGHWAY 329
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686-3049
Practice Address - Country:US
Practice Address - Phone:863-273-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW138231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical