Healthcare Provider Details

I. General information

NPI: 1841968104
Provider Name (Legal Business Name): CHRISTOPHER FLYNN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S MAIN ST
BLACKSBURG VA
24060-5210
US

IV. Provider business mailing address

106 EAKIN ST SW
BLACKSBURG VA
24060-4602
US

V. Phone/Fax

Practice location:
  • Phone: 540-250-7841
  • Fax:
Mailing address:
  • Phone: 540-250-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003771
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: