Provider Demographics
NPI:1649635913
Name:FLYNN, CHRISTINA (LW61326712)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LW61326712
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 8TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3294
Mailing Address - Country:US
Mailing Address - Phone:503-395-7363
Mailing Address - Fax:
Practice Address - Street 1:101 E 8TH ST STE 110
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3294
Practice Address - Country:US
Practice Address - Phone:503-395-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW61326712104100000X, 1041C0700X
ORL151171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker