1649318510 NPI number — MR. CHRISTOPHER JOHN FLANAGAN MSW, LCSW, LCAS

Table of content: MR. CHRISTOPHER JOHN FLANAGAN MSW, LCSW, LCAS (NPI 1649318510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649318510 NPI number — MR. CHRISTOPHER JOHN FLANAGAN MSW, LCSW, LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANAGAN
Provider First Name:
CHRISTOPHER
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, LCAS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649318510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 MOUNTAIN LAKE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-8912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-339-6606
Provider Business Mailing Address Fax Number:
919-438-4145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W PARKVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-5954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-433-0170
Provider Business Practice Location Address Fax Number:
919-226-0026
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 1176 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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