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General NPI Number Information
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NPI Number | 1326799081
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Entity Type | Organization
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Legal Business Name | AFFECT PROVIDER GROUP, P.S.C.
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 116 N 3RD ST STE 3
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City | DANVILLE
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State | KY
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Zip | 40422-1691
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Country | US
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Telephone | 845-769-8758
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Fax |
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Provider Business Mailing Address
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Address Line | 116 N 3RD ST STE 3
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City | DANVILLE
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State | KY
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Zip | 40422-1691
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Country | US
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Telephone | 951-691-9101
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | KARLA RENEE MULLINGS
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Credential | LCADC III
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Telephone | 845-769-8758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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