Healthcare Provider Details

I. General information

NPI: 1366161317
Provider Name (Legal Business Name): THE AFFIRMATIVE COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6642 S 193RD PL STE N106
KENT WA
98032-3109
US

IV. Provider business mailing address

PMB 632 10002 AURORA AVE N,
SEATTLE WA
98133
US

V. Phone/Fax

Practice location:
  • Phone: 253-271-9019
  • Fax:
Mailing address:
  • Phone:
  • 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

VIII. Authorized Official

Name: JAMIE LAYTON
Title or Position: TREASURER
Credential: MS, LMCHA
Phone: 253-271-9019