Provider Demographics
NPI:1407899164
Name:FLORES, EDWARD PAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PAUL
Last Name:FLORES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 NEWINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8672
Mailing Address - Country:US
Mailing Address - Phone:336-765-3032
Mailing Address - Fax:336-760-6977
Practice Address - Street 1:1396 OLD MILL CIRCLE
Practice Address - Street 2:SOTILE PSYCHOLOGICAL ASSOCIATES, PLLC
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-3032
Practice Address - Fax:336-760-6977
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO27161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical