Provider Demographics
NPI:1841837036
Name:AFFIRMATIVE SPACES PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:AFFIRMATIVE SPACES PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-770-7067
Mailing Address - Street 1:82 I ST SE APT 1307
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3793
Mailing Address - Country:US
Mailing Address - Phone:678-777-4036
Mailing Address - Fax:
Practice Address - Street 1:1200 G ST NW STE 800
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-6705
Practice Address - Country:US
Practice Address - Phone:202-770-7067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518379106OtherCOMMUNITY MENTAL HEALTH