Provider Demographics
NPI:1386857803
Name:FLANAGAN, SALLY LANIER (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:LANIER
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 TARA STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410
Mailing Address - Country:US
Mailing Address - Phone:912-656-0028
Mailing Address - Fax:912-898-0370
Practice Address - Street 1:3025 BULL ST
Practice Address - Street 2:#105
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-656-0028
Practice Address - Fax:912-898-0370
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPCGA002397101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor