Organization
KELLY E REDWINE LPC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY REDWINE LPC (OWNER)
(770) 695-7501
Entity
Organization
Contact information
Practice address
300 BROADWAY AVE, BRASELTON, GA 30517
(770) 695-7501
Mailing address
PO BOX 637, BRASELTON, GA 30517-0011
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/12/2021
Last updated
10/28/2021
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