Provider Demographics
NPI:1437595170
Name:REDDICK, PATRICE MARCELL (RN MAC,CMEC)
Entity type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:MARCELL
Last Name:REDDICK
Suffix:
Gender:F
Credentials:RN MAC,CMEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 OLD OLIVE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5914
Mailing Address - Country:US
Mailing Address - Phone:314-604-2626
Mailing Address - Fax:314-604-2626
Practice Address - Street 1:10420 OLD OLIVE STREET RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5914
Practice Address - Country:US
Practice Address - Phone:314-604-2626
Practice Address - Fax:314-696-8186
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional