Provider Demographics
NPI:1225703143
Name:AFFINITY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:AFFINITY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-324-4101
Mailing Address - Street 1:10632 HOLLY HOCK DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-5312
Mailing Address - Country:US
Mailing Address - Phone:225-324-4101
Mailing Address - Fax:
Practice Address - Street 1:10632 HOLLY HOCK DR
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-5312
Practice Address - Country:US
Practice Address - Phone:601-622-3342
Practice Address - Fax:601-510-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health