Provider Demographics
NPI:1730399056
Name:REDLINE, PAUL WILSON III (LMHC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WILSON
Last Name:REDLINE
Suffix:III
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6110 NW 27TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1991
Mailing Address - Country:US
Mailing Address - Phone:352-335-6721
Mailing Address - Fax:352-335-6721
Practice Address - Street 1:1505 NW 16TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4036
Practice Address - Country:US
Practice Address - Phone:352-335-6721
Practice Address - Fax:352-335-6721
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMH5328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health