Healthcare Provider Details

I. General information

NPI: 1104740620
Provider Name (Legal Business Name): FLOURISH HEALTH CHILD & ADOLESCENT PSYCHIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FALCON NEST CT
DURHAM NC
27713-8122
US

IV. Provider business mailing address

169 MADISON AVE STE 80170
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 910-447-6249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN HASKELL
Title or Position: SECRETARY
Credential:
Phone: 910-447-6249