Provider Demographics
NPI:1982139663
Name:REDDING, INGRID JOHNSON (AMFT)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:JOHNSON
Last Name:REDDING
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3056
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0305
Mailing Address - Country:US
Mailing Address - Phone:707-477-1115
Mailing Address - Fax:
Practice Address - Street 1:558 B ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5240
Practice Address - Country:US
Practice Address - Phone:707-278-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2021-04-02
Deactivation Date:2019-06-14
Deactivation Code:
Reactivation Date:2019-07-03
Provider Licenses
StateLicense IDTaxonomies
CAAMPT109689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist