Provider Demographics
NPI:1114528635
Name:FLAVIN, ROXIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:
Last Name:FLAVIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 PLYMOUTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3205
Mailing Address - Country:US
Mailing Address - Phone:734-929-4741
Mailing Address - Fax:
Practice Address - Street 1:3001 PLYMOUTH RD STE 101
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3205
Practice Address - Country:US
Practice Address - Phone:734-929-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68011155711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker