Provider Demographics
NPI:1699891671
Name:FLINT, DOUGLAS ALAN (MS LICENSED PSYCHO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALAN
Last Name:FLINT
Suffix:
Gender:M
Credentials:MS LICENSED PSYCHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 HIGHLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-4912
Mailing Address - Country:US
Mailing Address - Phone:802-334-1795
Mailing Address - Fax:802-334-1795
Practice Address - Street 1:494 HIGHLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4912
Practice Address - Country:US
Practice Address - Phone:802-334-1795
Practice Address - Fax:802-334-1795
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000605103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008294Medicaid
VT1008294Medicaid