Provider Demographics
NPI:1295758407
Name:FLORA, RUDOLPH (LCSW)
Entity type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:
Last Name:FLORA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2608
Mailing Address - Country:US
Mailing Address - Phone:276-628-5752
Mailing Address - Fax:
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2608
Practice Address - Country:US
Practice Address - Phone:276-628-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040021861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA116049OtherVALUE OPTIONS
VA238172OtherANTHEM BCBS VA-AB OFFICE
VA5095412OtherAETNA BEH HEALTH-ABING
VA1295758407Medicaid
VA00X431F01Medicare PIN
VA238172OtherANTHEM BCBS VA-AB OFFICE