Provider Demographics
NPI:1922597897
Name:FLACK, WILLIAM F JR (PHD)
Entity Type:Individual
Prefix:PROF
First Name:WILLIAM
Middle Name:F
Last Name:FLACK
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DENT DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-2029
Mailing Address - Country:US
Mailing Address - Phone:570-577-1131
Mailing Address - Fax:
Practice Address - Street 1:1 DENT DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-2029
Practice Address - Country:US
Practice Address - Phone:570-577-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7070-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical