Healthcare Provider Details

I. General information

NPI: 1457341216
Provider Name (Legal Business Name): MICHAEL P FLYNN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HUGUENOT RD STE 201
RICHMOND VA
23235-4311
US

IV. Provider business mailing address

PO BOX 35395
RICHMOND VA
23235-0395
US

V. Phone/Fax

Practice location:
  • Phone: 804-257-0912
  • Fax: 804-378-2078
Mailing address:
  • Phone: 804-257-0912
  • Fax: 804-378-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904000571
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: