Healthcare Provider Details

I. General information

NPI: 1497669980
Provider Name (Legal Business Name): AFFINITY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 TOWN FARM RD
UPPER MARLBORO MD
20774-8540
US

IV. Provider business mailing address

14101 TOWN FARM RD
UPPER MARLBORO MD
20774-8540
US

V. Phone/Fax

Practice location:
  • Phone: 910-237-3307
  • Fax:
Mailing address:
  • Phone: 910-237-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: FIDELIS SAMA ATABONG
Title or Position: CEO
Credential:
Phone: 910-237-3307