Provider Demographics
NPI:1679689673
Name:REDDICK, DOLORES THERESE (LCSW, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:THERESE
Last Name:REDDICK
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:MISS
Other - First Name:DOLORES
Other - Middle Name:THERESE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCDC
Mailing Address - Street 1:10414 ROCKING M TRL
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4033
Mailing Address - Country:US
Mailing Address - Phone:210-421-7779
Mailing Address - Fax:210-733-9916
Practice Address - Street 1:4415 W PIEDRAS DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1216
Practice Address - Country:US
Practice Address - Phone:210-733-9929
Practice Address - Fax:210-733-9916
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6460101YA0400X
TX27629104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1058Medicare ID - Type UnspecifiedCURRENT MCR #