Provider Demographics
NPI:1770747875
Name:REDWINE, LACINDA LEIGH (LMFT)
Entity type:Individual
Prefix:
First Name:LACINDA
Middle Name:LEIGH
Last Name:REDWINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LACINDA
Other - Middle Name:LEIGH
Other - Last Name:BARRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20748 E 810 RD
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-7901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20748 E 810 RD
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-7901
Practice Address - Country:US
Practice Address - Phone:405-699-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor