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General NPI Number Information
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NPI Number | 1235406109
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Entity Type | Organization
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Legal Business Name | REDLAK RECOVERY CENTER, PLLC
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10801 JOHNSTON RD STE 217
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City | CHARLOTTE
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State | NC
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Zip | 28226-7856
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Country | US
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Telephone | 704-654-9760
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Fax | 704-552-3705
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Provider Business Mailing Address
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Address Line | 3421 TWELVE OAKS PL
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City | CHARLOTTE
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State | NC
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Zip | 28270-4432
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Country | US
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Telephone | 704-654-9760
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Fax | 704-552-3705
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Authorized Official
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Title or Position | MANAGER-OWNER
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Name | DR. ANGELA SABINA REDLAK-OLCESE
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Credential | PSY.D.
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Telephone | 704-654-9760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3208
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License Number State | NC
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