Healthcare Provider Details

I. General information

NPI: 1801667167
Provider Name (Legal Business Name): AFF-ACTION WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 GRACE ST APT 3025
FRISCO TX
75034-4155
US

IV. Provider business mailing address

8455 GRACE ST APT 3025
FRISCO TX
75034-4155
US

V. Phone/Fax

Practice location:
  • Phone: 972-302-9151
  • Fax:
Mailing address:
  • Phone: 972-302-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALVEN TERRELL WEATHERSBY
Title or Position: CEO
Credential: LPC
Phone: 972-302-9151