Healthcare Provider Details

I. General information

NPI: 1801788286
Provider Name (Legal Business Name): AFFECT PROVIDER GROUP P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313C TRINDALE RD STE 205
ARCHDALE NC
27263-2751
US

IV. Provider business mailing address

PO BOX 96635
PHOENIX AZ
85072-6635
US

V. Phone/Fax

Practice location:
  • Phone: 845-769-8758
  • Fax:
Mailing address:
  • Phone: 845-769-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: KARLA RENEE MULLINGS
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 845-768-8758