Provider Demographics
NPI:1497538094
Name:REDDICK, SHEENA LYN (LPC RESIDENT)
Entity Type:Individual
Prefix:
First Name:SHEENA LYN
Middle Name:
Last Name:REDDICK
Suffix:
Gender:F
Credentials:LPC RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42395 RYAN RD STE 112-101
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4863
Mailing Address - Country:US
Mailing Address - Phone:910-813-8177
Mailing Address - Fax:
Practice Address - Street 1:120 BEULAH RD NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4745
Practice Address - Country:US
Practice Address - Phone:703-952-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional