Provider Demographics
NPI:1194398263
Name:FLANNICK, JACOB (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:FLANNICK
Suffix:
Gender:M
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2030
Mailing Address - Country:US
Mailing Address - Phone:724-561-7602
Mailing Address - Fax:
Practice Address - Street 1:54 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2030
Practice Address - Country:US
Practice Address - Phone:724-561-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health