Provider Demographics
NPI:1760972038
Name:AFFIRMATIVE TRANSFORMATION SERVICES, LLC
Entity Type:Organization
Organization Name:AFFIRMATIVE TRANSFORMATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:478-227-6144
Mailing Address - Street 1:507 AMBERLEY CT
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2845
Mailing Address - Country:US
Mailing Address - Phone:478-225-3444
Mailing Address - Fax:
Practice Address - Street 1:507 AMBERLEY CT
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2845
Practice Address - Country:US
Practice Address - Phone:478-227-6144
Practice Address - Fax:866-554-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007036101YA0400X, 101YP2500X
GA1393590101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty