Provider Demographics
NPI:1053177014
Name:FLECKENSTEIN, PHILLIP (LMSW)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:FLECKENSTEIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 DUNLON CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6575
Mailing Address - Country:US
Mailing Address - Phone:806-544-2773
Mailing Address - Fax:
Practice Address - Street 1:6215 HIGHWAY 707
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7362
Practice Address - Country:US
Practice Address - Phone:843-273-0077
Practice Address - Fax:843-273-0075
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC132311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical