Provider Demographics
NPI:1679825533
Name:REDMOND COUNSELING LLC
Entity Type:Organization
Organization Name:REDMOND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC, QMRP
Authorized Official - Phone:616-915-4769
Mailing Address - Street 1:779 SCOTT WOODS DR NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9617
Mailing Address - Country:US
Mailing Address - Phone:616-915-4769
Mailing Address - Fax:
Practice Address - Street 1:779 SCOTT WOODS DR NE
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-9617
Practice Address - Country:US
Practice Address - Phone:616-915-4769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020836401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty