Provider Demographics
NPI:1710619580
Name:AFFECT PROVIDER GROUP, P.S.C.
Entity Type:Organization
Organization Name:AFFECT PROVIDER GROUP, P.S.C.
Other - Org Name:AFFECT PROVIDER GROUP, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MULLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-768-8758
Mailing Address - Street 1:116 N 3RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1691
Mailing Address - Country:US
Mailing Address - Phone:845-769-8785
Mailing Address - Fax:888-398-1839
Practice Address - Street 1:313 TRINDALE RD # A
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3800
Practice Address - Country:US
Practice Address - Phone:845-769-8758
Practice Address - Fax:888-398-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility