Provider Demographics
NPI:1124670302
Name:REDMOND, VIRGINIA C S
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:C S
Last Name:REDMOND
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:C
Other - Last Name:REDMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1305 21ST AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6084
Mailing Address - Country:US
Mailing Address - Phone:907-474-0059
Mailing Address - Fax:
Practice Address - Street 1:1305 21ST AVE STE 204
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6084
Practice Address - Country:US
Practice Address - Phone:907-474-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 390200000X
AK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program