Healthcare Provider Details

I. General information

NPI: 1912247180
Provider Name (Legal Business Name): AFFINITY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W TOWN ST
NORWICH CT
06360-2239
US

IV. Provider business mailing address

20 CARVER AVE
NORWICH CT
06360-3316
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-8233
  • Fax: 860-886-8029
Mailing address:
  • Phone: 860-886-8233
  • Fax: 860-886-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIE A LONGTON
Title or Position: CO-OWNER
Credential: LMFT
Phone: 860-886-8233