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General NPI Number Information
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NPI Number | 1720464381
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Entity Type | Organization
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Legal Business Name | AFFINITY COUNSELING CENTER
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 1030 ANDREWS HWY SUITE 108
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City | MIDLAND
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State | TX
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Zip | 79701-3872
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Country | US
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Telephone | 432-557-1775
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Fax | 432-557-1775
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Provider Business Mailing Address
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Address Line | 1030 ANDREWS HWY SUITE 108
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City | MIDLAND
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State | TX
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Zip | 79701-3872
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Country | US
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Telephone | 432-557-1775
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Fax | 432-557-1775
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CHERYL WILLOUGHBY
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Credential | LPC
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Telephone | 432-557-1775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 67676
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License Number State | TX
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