Provider Demographics
NPI:1619254505
Name:THERAPY FLOW
Entity Type:Organization
Organization Name:THERAPY FLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:TEDDY
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-265-2919
Mailing Address - Street 1:824 GUM BRANCH RD
Mailing Address - Street 2:SUITE B. ROOM 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6272
Mailing Address - Country:US
Mailing Address - Phone:910-265-2919
Mailing Address - Fax:910-355-2427
Practice Address - Street 1:824 GUM BRANCH RD
Practice Address - Street 2:SUITE B. ROOM 4
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6272
Practice Address - Country:US
Practice Address - Phone:910-265-2919
Practice Address - Fax:910-355-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6904251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104045Medicaid