Provider Demographics
NPI:1699259812
Name:FLOWER, TRAVIS DRAKE (PSYD, JD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:DRAKE
Last Name:FLOWER
Suffix:
Gender:M
Credentials:PSYD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 TENNESSEE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1225
Mailing Address - Country:US
Mailing Address - Phone:302-388-4488
Mailing Address - Fax:
Practice Address - Street 1:3412 TENNESSEE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1225
Practice Address - Country:US
Practice Address - Phone:302-388-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical