Provider Demographics
NPI:1972899029
Name:FLYNN, SUSAN D (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 MARTIN LUTHER KING RD
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6001
Mailing Address - Country:US
Mailing Address - Phone:704-622-9267
Mailing Address - Fax:843-314-9261
Practice Address - Street 1:534 MARTIN LUTHER KING RD
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6001
Practice Address - Country:US
Practice Address - Phone:704-622-9267
Practice Address - Fax:843-314-9261
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health