Provider Demographics
NPI:1861264608
Name:FLOGE, DAVID JONATHAN
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JONATHAN
Last Name:FLOGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 ODELL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7476
Mailing Address - Country:US
Mailing Address - Phone:704-310-7842
Mailing Address - Fax:
Practice Address - Street 1:4402 ODELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7476
Practice Address - Country:US
Practice Address - Phone:704-310-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional