Provider Demographics
NPI:1063704948
Name:REDD, ROSELLA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ROSELLA
Middle Name:MARIE
Last Name:REDD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 W HORIZON RIDGE PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-6020
Mailing Address - Country:US
Mailing Address - Phone:702-405-0904
Mailing Address - Fax:702-405-0924
Practice Address - Street 1:1070 W HORIZON RIDGE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-6020
Practice Address - Country:US
Practice Address - Phone:702-405-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2003576593251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health