Basic Information
| Provider Information | |||||||||
| NPI: | 1649318510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLANAGAN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LCSW, LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 MOUNTAIN LAKE CT | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277138912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193396606 | ||||||||
| FaxNumber: | 9194384145 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W PARKVIEW DR | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275365954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194330170 | ||||||||
| FaxNumber: | 9192260026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 06/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 1176 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.