Provider Demographics
NPI:1720464381
Name:AFFINITY COUNSELING CENTER
Entity Type:Organization
Organization Name:AFFINITY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:432-557-1775
Mailing Address - Street 1:1030 ANDREWS HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3872
Mailing Address - Country:US
Mailing Address - Phone:432-557-1775
Mailing Address - Fax:432-557-1775
Practice Address - Street 1:1030 ANDREWS HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3872
Practice Address - Country:US
Practice Address - Phone:432-557-1775
Practice Address - Fax:432-557-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67676101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty