Healthcare Provider Details

I. General information

NPI: 1033820212
Provider Name (Legal Business Name): AFFINITY TRIANGLE THERAPY, COACHING & SUPERVISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9612 WELLS PKWY
NORFOLK VA
23503-1720
US

IV. Provider business mailing address

9612 WELLS PKWY
NORFOLK VA
23503-1720
US

V. Phone/Fax

Practice location:
  • Phone: 304-888-2910
  • Fax:
Mailing address:
  • Phone: 304-888-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: SONNEE D STANLEY
Title or Position: OWNER
Credential: M.ED.
Phone: 304-888-2910