1093135162 NPI number — CLAIRE STEPHENSON FLANSBURG PH.D., LCP

Table of content: CLAIRE STEPHENSON FLANSBURG PH.D., LCP (NPI 1093135162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093135162 NPI number — CLAIRE STEPHENSON FLANSBURG PH.D., LCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANSBURG
Provider First Name:
CLAIRE
Provider Middle Name:
STEPHENSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D., LCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEPHENSON
Provider Other First Name:
JOAN
Provider Other Middle Name:
CLAIRE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093135162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9025 FOREST HILL AVE STE 2A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N 27TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23223-6507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-668-7220
Provider Business Practice Location Address Fax Number:
804-668-7220
Provider Enumeration Date:
04/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810005340 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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