Provider Demographics
NPI:1467018242
Name:REDDING, CRYSTAL MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:MARIE
Last Name:REDDING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 RAINER CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8263
Mailing Address - Country:US
Mailing Address - Phone:910-922-3242
Mailing Address - Fax:
Practice Address - Street 1:1300 BENSON RD STE 106
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4687
Practice Address - Country:US
Practice Address - Phone:919-594-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WY690103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist