Provider Demographics
NPI:1689616674
Name:FLORA, EARL WAYNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:WAYNE
Last Name:FLORA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:NORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23127-0564
Mailing Address - Country:US
Mailing Address - Phone:757-564-8522
Mailing Address - Fax:757-566-0360
Practice Address - Street 1:3305 POPLAR CREEK LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1058
Practice Address - Country:US
Practice Address - Phone:757-564-8522
Practice Address - Fax:757-566-0360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA031312OtherVALUE OPTIONS
VA095271OtherBCBSVA
VA86196OtherSENTARA MENTAL HEALTH
VA152183OtherCOMPSYCH
VA244496OtherMHN
VA271332OtherPHCS
VA271332OtherPHCS