Provider Demographics
NPI:1104168640
Name:FLORES, WILLIAM (LCSW/CAP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:LCSW/CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2216
Mailing Address - Country:US
Mailing Address - Phone:863-797-9163
Mailing Address - Fax:963-937-4069
Practice Address - Street 1:7334 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2216
Practice Address - Country:US
Practice Address - Phone:863-797-9163
Practice Address - Fax:963-937-4069
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW110201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW11020OtherLISCENSE