Provider Demographics
NPI:1841840733
Name:AFFECT OPTIMUM BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:AFFECT OPTIMUM BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:MARYANN
Authorized Official - Last Name:OKUDOH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PHMNP-B, FNP-BC
Authorized Official - Phone:301-332-7222
Mailing Address - Street 1:1818 NEW YORK AVE NE STE 215
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1849
Mailing Address - Country:US
Mailing Address - Phone:301-332-7222
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE STE 215
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1849
Practice Address - Country:US
Practice Address - Phone:301-332-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFECT OPTIMUM BEHAVIORAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-13
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty