Healthcare Provider Details

I. General information

NPI: 1518619311
Provider Name (Legal Business Name): MEREDITH REDLIN HARRIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 PROFESSIONAL CIR STE B
MARTINEZ GA
30907-8234
US

IV. Provider business mailing address

3506 PROFESSIONAL CIR STE B
MARTINEZ GA
30907-8234
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-8855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC007047
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: