Provider Demographics
NPI:1962883454
Name:FLAGG, CHARLENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:FLAGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6686 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2043
Mailing Address - Country:US
Mailing Address - Phone:616-350-4672
Mailing Address - Fax:
Practice Address - Street 1:6686 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-2043
Practice Address - Country:US
Practice Address - Phone:616-350-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0052441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical