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General NPI Number Information
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NPI Number | 1851860878
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Entity Type | Organization
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Legal Business Name | AFC PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 1251 N EDDY ST STE 200
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City | SOUTH BEND
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State | IN
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Zip | 46617-1478
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Country | US
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Telephone | 574-307-9147
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Fax | 574-213-6884
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Provider Business Mailing Address
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Address Line | 1251 N EDDY ST STE 200
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City | SOUTH BEND
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State | IN
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Zip | 46617-1478
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Country | US
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Telephone | 574-307-9147
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Fax | 574-213-6884
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ALEXANDRA FILIA CORNING
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Credential | PHD
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Telephone | 574-307-9147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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