Healthcare Provider Details

I. General information

NPI: 1528803442
Provider Name (Legal Business Name): WILLIAM K FLEGAL JR. LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 01/24/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NORTH BULTMAN DR
SUMTER SC
29150
US

IV. Provider business mailing address

30 PARLIAMENT CT
SUMTER SC
29154-7367
US

V. Phone/Fax

Practice location:
  • Phone: 803-938-9901
  • Fax:
Mailing address:
  • Phone: 706-996-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16888
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: