Provider Demographics
NPI:1508743626
Name:REDICK, SUZZET (LCDC CI)
Entity type:Individual
Prefix:
First Name:SUZZET
Middle Name:
Last Name:REDICK
Suffix:
Gender:F
Credentials:LCDC CI
Other - Prefix:
Other - First Name:SUZZET
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3191 RED ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4593
Mailing Address - Country:US
Mailing Address - Phone:915-218-8830
Mailing Address - Fax:
Practice Address - Street 1:6111 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-4734
Practice Address - Country:US
Practice Address - Phone:915-221-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64546101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)