Individual provider Active NPI

Consuelo Reddick, M.D.

  • Child & Adolescent Psychiatry Physician
  • Roswell, GA
National Provider Identifier
1437214350
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
044067 Issued in GA
Practice address
300 Colonial Center Pkwy Ste 100
Roswell, GA 30076-4892
Phone
(470) 670-6319
Fax
(888) 815-3583
NPI assigned
Dec 22, 2006
Last updated
Feb 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 61047950 WA
Psychiatry Physician 2084P0800X 89249 MT
Psychiatry Physician 2084P0800X G133049 CA
Child & Adolescent Psychiatry Physician 2084P0804X MD199050 OR
Psychiatry Physician 2084P0800X 61047950 WA
Psychiatry Physician 2084P0800X 044067 GA
Child & Adolescent Psychiatry Physician 2084P0804X 044067 GA Primary
Child & Adolescent Psychiatry Physician 2084P0804X 89249 MT
Psychiatry Physician 2084P0800X MD199050 OR
Child & Adolescent Psychiatry Physician 2084P0804X G133049 CA

Addresses

Primary practice location

300 Colonial Center Pkwy Ste 100
Roswell, GA 30076-4892

Mailing address

400 Union Ave SE Ste 200
Olympia, WA 98501-2060
Phone (833) 351-8255

Other practice location 1

9620 NE Tanasbourne Dr Ste 300
Hillsboro, OR 97124-7844
Phone (833) 351-8255

Other practice location 2

2310 N 7th Ave Ste A
Bozeman, MT 59715-2550
Phone (833) 351-8255

Other practice location 3

400 Union Ave SE Ste 200
Olympia, WA 98501-2060
Phone (833) 351-8255

Other practice location 4

77 E Crossville Rd Ste 206
Roswell, GA 30075-3086
Phone (770) 552-4655

Other practice location 5

100 Pine St Ste 1250
San Francisco, CA 94111-5235
Phone (833) 351-8255

Other identifiers 1

IdentifierTypeStateIssuer
00024706MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070305000340 GA Practitioner - Psychiatry 3173625563 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
044067GAMDPsychiatry Physician
89249MTMDPsychiatry Physician
G133049CAMDChild & Adolescent Psychiatry Physician
MD199050ORMDChild & Adolescent Psychiatry Physician
61047950WAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Psychology Center, LLC Psychiatry CurrentSince Feb 1, 2015 Accepting new patients
Roswell Psychiatric Services, PC Psychiatry Current Accepting new patients
Highland Rivers CSB CurrentSince Jan 23, 2015 Accepting new patients
Highland Rivers Community Service Board Current Accepting new patients
Highland Rivers Community Service Board CurrentSince Jan 23, 2015 Accepting new patients
MCCD FL Psychiatry Services PA Psychiatry CurrentSince Oct 19, 2025 Accepting new patients
Georgia Mountains Community Services Past Accepting new patients

Locations

191 Lamar Haley Pkwy
Canton, GA 30114
Phone (770) 704-1600

2900 Chamblee Tucker Rd
Bldg 16
Chamblee, GA 30341
Phone (770) 939-1288

1401 Applewood Dr
Ste 1
Dalton, GA 30720
Phone (706) 270-5003

1503 N Tibbs Rd
Dalton, GA 30720
Phone (706) 229-4507

300 Colonial Center Pkwy
Ofc 12
Roswell, GA 30076
Phone (833) 351-1825

77 E Crossville Rd
Ste 206
Roswell, GA 30075
Phone (770) 552-4655

10 Glenlake Pkwy
Ste 130
Sandy Springs, GA 30328
Phone (678) 230-7095

2310 N 7th Ave
Ste A
Bozeman, MT 59715

9620 NE Tanasbourne Dr
Ste 300
Hillsboro, OR 97124
Phone (833) 756-8643

400 Union Ave SE
Ste 200
Olympia, WA 98501
Phone (202) 375-4508

Interoperability endpoints

  • Direct secure messaging: creddick1258001@ak.providencedirect.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1437214350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 UNION AVE SE STE 200",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985012060",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLONIAL CENTER PKWY STE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764892",
            "telephone_number": "470-670-6319",
            "fax_number": "888-815-3583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9620 NE Tanasbourne Dr Ste 300",
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            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971247844",
            "country_code": "US",
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            "fax_number": "888-815-3583",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2310 N 7th Ave Ste A",
            "address_purpose": "LOCATION",
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        },
        {
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        },
        {
            "address_1": "77 E Crossville Rd Ste 206",
            "address_purpose": "LOCATION",
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            "postal_code": "300753086",
            "country_code": "US",
            "telephone_number": "770-552-4655",
            "fax_number": "770-552-4282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Pine St Ste 1250",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941115235",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REDDICK",
        "first_name": "CONSUELO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-22",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WA",
            "license": "61047950",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MT",
            "license": "89249",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G133049",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OR",
            "license": "MD199050",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "61047950",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "044067",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "GA",
            "license": "044067",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MT",
            "license": "89249",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD199050",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "G133049",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00024706",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.