Provider Demographics
NPI:1073353074
Name:REDWINE, ELIZABETH DERRICK (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DERRICK
Last Name:REDWINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MORGAN
Other - Last Name:DERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:632 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1247
Mailing Address - Country:US
Mailing Address - Phone:615-477-8406
Mailing Address - Fax:
Practice Address - Street 1:632 JAMES AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-1247
Practice Address - Country:US
Practice Address - Phone:615-477-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical