Provider Demographics
NPI:1124482559
Name:REDMON, VIRGINIA (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:REDMON
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 1:3061 TUSCALOOSA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5457
Mailing Address - Country:US
Mailing Address - Phone:859-559-2465
Mailing Address - Fax:
Practice Address - Street 1:120 CHRYSALIS CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2604
Practice Address - Country:US
Practice Address - Phone:859-243-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2527461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical