Provider Demographics
NPI:1811971781
Name:REDNER, CHARLENE K (MFT INTERN)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:K
Last Name:REDNER
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 1ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6529
Mailing Address - Country:US
Mailing Address - Phone:619-234-2158
Mailing Address - Fax:619-234-1979
Practice Address - Street 1:2602 1ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6529
Practice Address - Country:US
Practice Address - Phone:619-234-2158
Practice Address - Fax:619-234-1979
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF45895101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)