Provider Demographics
NPI:1578820114
Name:REDD, CRYSTAL DEANNA (LPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DEANNA
Last Name:REDD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 LILY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-1775
Mailing Address - Country:US
Mailing Address - Phone:630-768-9645
Mailing Address - Fax:205-339-7246
Practice Address - Street 1:2611 LILY WAY
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-1775
Practice Address - Country:US
Practice Address - Phone:630-768-9645
Practice Address - Fax:205-339-7246
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AL4173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health