Provider Demographics
NPI:1740570993
Name:AFFINITY FAMILY SUPPORT SERVICES PC
Entity Type:Organization
Organization Name:AFFINITY FAMILY SUPPORT SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-835-1700
Mailing Address - Street 1:1324 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2462
Mailing Address - Country:US
Mailing Address - Phone:814-835-1700
Mailing Address - Fax:814-835-1701
Practice Address - Street 1:1324 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2462
Practice Address - Country:US
Practice Address - Phone:814-835-1700
Practice Address - Fax:814-835-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013620251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health