Healthcare Provider Details

I. General information

NPI: 1245546282
Provider Name (Legal Business Name): ARTEMUS FLAGG PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 E HARRIS BLVD STE D
CHARLOTTE NC
28215-5135
US

IV. Provider business mailing address

6612 E HARRIS BLVD STE D
CHARLOTTE NC
28215-5135
US

V. Phone/Fax

Practice location:
  • Phone: 704-567-8984
  • Fax: 704-567-8954
Mailing address:
  • Phone: 704-567-8985
  • Fax: 704-567-8954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8075
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8075
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8075
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: