Provider Demographics
NPI:1245546282
Name:FLAGG, ARTEMUS (PH D)
Entity type:Individual
Prefix:DR
First Name:ARTEMUS
Middle Name:
Last Name:FLAGG
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 E HARRIS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5135
Mailing Address - Country:US
Mailing Address - Phone:704-567-8985
Mailing Address - Fax:704-567-8954
Practice Address - Street 1:6612 E HARRIS BLVD STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5135
Practice Address - Country:US
Practice Address - Phone:704-567-8984
Practice Address - Fax:704-567-8954
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8075101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health