Provider Demographics
NPI:1871654368
Name:REDLAK-OLCESE, ANGELA SABINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:SABINA
Last Name:REDLAK-OLCESE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:SABINA
Other - Last Name:REDLAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:10801 JOHNSTON RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-654-9760
Mailing Address - Fax:772-672-3667
Practice Address - Street 1:10801 JOHNSTON RD
Practice Address - Street 2:SUITE 217
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-654-9760
Practice Address - Fax:772-672-3667
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000869Medicaid