Provider Demographics
NPI:1083634661
Name:FLATLEY, MARGARET MITCHELL
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MITCHELL
Last Name:FLATLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:SCRIPTURE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:806 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5312
Mailing Address - Country:US
Mailing Address - Phone:910-860-7008
Mailing Address - Fax:910-221-9006
Practice Address - Street 1:806 HAY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5312
Practice Address - Country:US
Practice Address - Phone:910-860-7008
Practice Address - Fax:910-221-9006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPA #2452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137PAOtherBC/BS PROVIDER NUMBER
NC6107200Medicaid
NC8943Medicaid