Provider Demographics
NPI:1457341216
Name:FLYNN, MICHAEL P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:FLYNN
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:PO BOX 35395
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0395
Mailing Address - Country:US
Mailing Address - Phone:804-257-0912
Mailing Address - Fax:804-378-2078
Practice Address - Street 1:1901 HUGUENOT RD
Practice Address - Street 2:STE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4311
Practice Address - Country:US
Practice Address - Phone:804-257-0912
Practice Address - Fax:804-378-2078
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA245957000OtherMAGELLAN BEHAVIORAL HEALTH
VA008936536Medicaid
VA050502OtherBCBS
VA008908559Medicaid
VA205537OtherMHN
VAO85750OtherOPTIMA
VA031984OtherVALUE OPTIONS
VA222422OtherBCBS
VA205537OtherTRICARE
VAO85750OtherOPTIMA
VA008936536Medicaid