Provider Demographics
NPI:1588768824
Name:REDGWAY, STEPHEN G II (MD LPC CDC CCDP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:REDGWAY
Suffix:II
Gender:M
Credentials:MD LPC CDC CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438
Mailing Address - Country:US
Mailing Address - Phone:215-256-3166
Mailing Address - Fax:
Practice Address - Street 1:600 CREEKSIDE DR
Practice Address - Street 2:SUITE 609
Practice Address - City:SANATOGA
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-327-1631
Practice Address - Fax:610-327-1199
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000834101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health