Provider Demographics
NPI:1538525472
Name:FLAGG, CONSTANCE E (LADC)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:E
Last Name:FLAGG
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WEST ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3361
Mailing Address - Country:US
Mailing Address - Phone:603-355-0160
Mailing Address - Fax:603-355-0159
Practice Address - Street 1:33 WEST ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3361
Practice Address - Country:US
Practice Address - Phone:603-355-0160
Practice Address - Fax:603-355-0159
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH352101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH352OtherBOARD OF LICENSING FOR ALCOHOL AND OTHER DRUG USE PROFESSIONALS