Provider Demographics
NPI:1801050802
Name:REDMON, FELICIA W (MS,MDIV,DMIN(C),BCC)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:W
Last Name:REDMON
Suffix:
Gender:F
Credentials:MS,MDIV,DMIN(C),BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 APSLEY CT
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9313
Mailing Address - Country:US
Mailing Address - Phone:336-274-7094
Mailing Address - Fax:336-274-2296
Practice Address - Street 1:620 SOUTH ELM STREET
Practice Address - Street 2:SUITE 364
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27400-1370
Practice Address - Country:US
Practice Address - Phone:336-274-7094
Practice Address - Fax:336-274-2296
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X, 101YM0800X, 101YP1600X, 101YS0200X, 106H00000X
VA01-326091101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist