=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881490654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A FAMILY AFFAIRE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2025
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3069 WALLINGFORD AVE # AVW
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43231-6027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-233-1678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1421
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43086-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-233-1678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CHERIECE MOORE
-----------------------------------------------------
Credential | LISW
-----------------------------------------------------
Telephone | 614-233-1678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------