Provider Demographics
NPI:1518303833
Name:REDFEARN, ANTHONY TC (LMFT/LPC/LCAS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TC
Last Name:REDFEARN
Suffix:
Gender:M
Credentials:LMFT/LPC/LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-7030
Mailing Address - Country:US
Mailing Address - Phone:704-492-2436
Mailing Address - Fax:704-303-9457
Practice Address - Street 1:2718 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-7030
Practice Address - Country:US
Practice Address - Phone:704-492-2436
Practice Address - Fax:704-303-9457
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X
NC9307101YM0800X
NC2472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional