Provider Demographics
NPI:1639764533
Name:REDICE, KIARA SHARNESE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:SHARNESE
Last Name:REDICE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 LONG PAW LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-9417
Mailing Address - Country:US
Mailing Address - Phone:704-617-4306
Mailing Address - Fax:
Practice Address - Street 1:233 S. AMITY RD
Practice Address - Street 2:STE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2821
Practice Address - Country:US
Practice Address - Phone:980-613-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health