Provider Demographics
NPI:1558884338
Name:AFRICAN DIASPORA MENTAL HEALTH ASSOCIATION LLC.
Entity Type:Organization
Organization Name:AFRICAN DIASPORA MENTAL HEALTH ASSOCIATION LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LICSW, LADC 1
Authorized Official - Phone:413-262-7414
Mailing Address - Street 1:605 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-4114
Mailing Address - Country:US
Mailing Address - Phone:413-266-2207
Mailing Address - Fax:413-301-5164
Practice Address - Street 1:605 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4114
Practice Address - Country:US
Practice Address - Phone:413-262-7414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)