Provider Demographics
NPI:1912524166
Name:AFFINITY COUNSELING & WELLNESS
Entity Type:Organization
Organization Name:AFFINITY COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCMHCS
Authorized Official - Phone:336-893-9705
Mailing Address - Street 1:3143 S STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5948
Mailing Address - Country:US
Mailing Address - Phone:336-893-9705
Mailing Address - Fax:336-893-9705
Practice Address - Street 1:3143 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5948
Practice Address - Country:US
Practice Address - Phone:336-893-9705
Practice Address - Fax:336-893-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty