Provider Demographics
NPI:1548433097
Name:AFFINITY COUNSELING, INC.
Entity Type:Organization
Organization Name:AFFINITY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:714-330-9627
Mailing Address - Street 1:11110 LOS ALAMITOS BLVD
Mailing Address - Street 2:STE. 202
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3602
Mailing Address - Country:US
Mailing Address - Phone:714-330-9627
Mailing Address - Fax:
Practice Address - Street 1:11110 LOS ALAMITOS BLVD
Practice Address - Street 2:STE. 202
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3602
Practice Address - Country:US
Practice Address - Phone:714-330-9627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18674103T00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty