Provider Demographics
NPI:1033169990
Name:FLOWERS, JEFF T (LPC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:T
Last Name:FLOWERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRIDGEWATER CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7905
Mailing Address - Country:US
Mailing Address - Phone:910-265-2919
Mailing Address - Fax:910-355-2427
Practice Address - Street 1:824 GUM BRANCH RD STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6269
Practice Address - Country:US
Practice Address - Phone:910-265-2919
Practice Address - Fax:910-355-2427
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4282101YP2500X
NC6904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104045Medicaid