Provider Demographics
NPI:1659738037
Name:REDMON, THERESA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:REDMON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GATEWAY DRIVE
Mailing Address - Street 2:SUITE 11-12A
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:443-528-9041
Mailing Address - Fax:
Practice Address - Street 1:3018 BENEFIT CT
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2942
Practice Address - Country:US
Practice Address - Phone:410-569-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional