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General NPI Number Information
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NPI Number | 1013655232
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Entity Type | Individual
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Provider Name | GEORGE D AFFONSO LADC I, CADC
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Gender | Male
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 60 CHERRY ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-4466
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Country | US
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Telephone | 508-746-6654
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Fax | 508-746-2433
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Provider Business Mailing Address
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Address Line | 11A STANDISH AVE
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City | PLYMOUTH
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State | MA
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Zip | 02360-4145
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Country | US
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Telephone | 501-626-8050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16860
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License Number State | MA
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