Provider Demographics
NPI:1528599263
Name:FLINT, PHYLLIS (CDCA)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:FLINT
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S PORTAGE PATH
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2325
Mailing Address - Country:US
Mailing Address - Phone:330-253-4597
Mailing Address - Fax:330-253-4949
Practice Address - Street 1:365 S PORTAGE PATH
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2325
Practice Address - Country:US
Practice Address - Phone:330-253-4597
Practice Address - Fax:330-253-4949
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)