Healthcare Provider Details

I. General information

NPI: 1639347636
Provider Name (Legal Business Name): ANGELA M REDWINE PH.D., LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5736 MANCHESTER HWY
MORRISON TN
37357-7503
US

IV. Provider business mailing address

PO BOX 640
MCMINNVILLE TN
37111-0640
US

V. Phone/Fax

Practice location:
  • Phone: 931-815-3871
  • Fax:
Mailing address:
  • Phone: 931-507-1212
  • Fax: 931-507-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2784
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: