Healthcare Provider Details

I. General information

NPI: 1720574205
Provider Name (Legal Business Name): SAMANTHA GRACE FLYNN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 CHAPEL HILL RD
DURHAM NC
27707-1109
US

IV. Provider business mailing address

1 BOULDER RIDGE RD
ASHEVILLE NC
28806-0256
US

V. Phone/Fax

Practice location:
  • Phone: 919-230-8464
  • Fax:
Mailing address:
  • Phone: 610-639-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014877
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: