Healthcare Provider Details

I. General information

NPI: 1962883454
Provider Name (Legal Business Name): CHARLENE FLAGG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 GEES MILL RD NE STE 210
CONYERS GA
30013-1360
US

IV. Provider business mailing address

2047 GEES MILL RD NE STE 210
CONYERS GA
30013-1360
US

V. Phone/Fax

Practice location:
  • Phone: 678-764-4697
  • Fax:
Mailing address:
  • Phone: 678-764-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: