Provider Demographics
NPI:1730475385
Name:CAREY-REDIC, MICHELLE MARIE (LCDC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:CAREY-REDIC
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 N W FWY
Mailing Address - Street 2:SUITE 460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6530
Mailing Address - Country:US
Mailing Address - Phone:713-682-3200
Mailing Address - Fax:
Practice Address - Street 1:11500 N W FWY
Practice Address - Street 2:SUITE 460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6530
Practice Address - Country:US
Practice Address - Phone:713-682-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10639101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)