Provider Demographics
NPI:1881690048
Name:REDWINE, SONDRA MICHELLE (M ED)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:MICHELLE
Last Name:REDWINE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:S
Other - Middle Name:MICHELLE
Other - Last Name:REDWINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6632 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8132
Mailing Address - Country:US
Mailing Address - Phone:817-605-1219
Mailing Address - Fax:
Practice Address - Street 1:6632 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8132
Practice Address - Country:US
Practice Address - Phone:817-605-1219
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional