Provider Demographics
NPI:1871180356
Name:AFANGIDEH THERAPY
Entity Type:Organization
Organization Name:AFANGIDEH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UDUAK
Authorized Official - Middle Name:
Authorized Official - Last Name:AFANGIDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-549-9757
Mailing Address - Street 1:5293 COCHRAN CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-4827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39A CAROL VILLA DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-4221
Practice Address - Country:US
Practice Address - Phone:334-549-9757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty