Provider Demographics
NPI:1578682837
Name:REDMOND, KERRY SHAWN (LCAS)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:SHAWN
Last Name:REDMOND
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S FRENCH BROAD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3272
Mailing Address - Country:US
Mailing Address - Phone:828-225-3100
Mailing Address - Fax:828-225-3604
Practice Address - Street 1:271A CALLAHAN KOON RD
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-2207
Practice Address - Country:US
Practice Address - Phone:828-287-6110
Practice Address - Fax:828-287-6092
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1170101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301118QOtherENHANCED MEDICAID
NC6111944Medicaid