Provider Demographics
NPI:1922332188
Name:AFFINITY COUNSELING AND TREATMENT
Entity Type:Organization
Organization Name:AFFINITY COUNSELING AND TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-314-6507
Mailing Address - Street 1:12503 SE MILL PLAIN BLVD
Mailing Address - Street 2:119A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4009
Mailing Address - Country:US
Mailing Address - Phone:360-314-6507
Mailing Address - Fax:360-852-8041
Practice Address - Street 1:12503 SE MILL PLAIN BLVD
Practice Address - Street 2:119A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4009
Practice Address - Country:US
Practice Address - Phone:360-314-6507
Practice Address - Fax:360-852-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA06158100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health