Healthcare Provider Details

I. General information

NPI: 1942831748
Provider Name (Legal Business Name): VICTORIA ANN FLYNN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 TAVERN RD
MARTINSBURG WV
25401-2890
US

IV. Provider business mailing address

PO BOX 1146
MARTINSBURG WV
25402-1146
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-4999
  • Fax: 304-263-0984
Mailing address:
  • Phone: 304-263-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00945504
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: