Provider Demographics
NPI:1417597501
Name:FLOWERS, JACQUELINE RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RAE
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:RAE
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3015 APPLING WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9277
Mailing Address - Country:US
Mailing Address - Phone:305-301-7894
Mailing Address - Fax:
Practice Address - Street 1:2608 ERWIN RD STE 300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4597
Practice Address - Country:US
Practice Address - Phone:919-698-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5658OtherPSYCHOLOGIST LICENSE