Provider Demographics
NPI:1063071421
Name:REDMOND, BENJAMIN ELON
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ELON
Last Name:REDMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1709
Mailing Address - Country:US
Mailing Address - Phone:304-993-8685
Mailing Address - Fax:304-768-5508
Practice Address - Street 1:1215A STEWART PLZ
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3021
Practice Address - Country:US
Practice Address - Phone:304-768-5506
Practice Address - Fax:304-768-5508
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional