Provider Demographics
NPI:1346314838
Name:FLINTON, CHARLES ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALAN
Last Name:FLINTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 REDWOOD RD STE 10
Mailing Address - Street 2:#383
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2363
Mailing Address - Country:US
Mailing Address - Phone:415-391-7171
Mailing Address - Fax:415-391-7177
Practice Address - Street 1:4100 REDWOOD RD STE 10
Practice Address - Street 2:#383
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2363
Practice Address - Country:US
Practice Address - Phone:415-391-7171
Practice Address - Fax:415-391-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16095103T00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical