| Affect Provider Group, P.s.c. | |
|
12410 Milestone Center Dr Ofc 670 Germantown MD 20876-7101 | |
| (951) 691-9101 | |
| Not Available |
| Full Name | Affect Provider Group, P.s.c. |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 12410 Milestone Center Dr Ofc 670, Germantown, Maryland |
| Authorized Official Name and Position | Karla Renee Mullings (DIR. OF COMPLIANCE) |
| Authorized Official Contact | 8457688758 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Affect Provider Group, P.s.c. 1640 Boro Pl Fl 4 Mc Lean VA 22102-3627 Ph: (951) 691-9101 | Affect Provider Group, P.s.c. 12410 Milestone Center Dr Ofc 670 Germantown MD 20876-7101 Ph: (951) 691-9101 |
| NPI Number | 1962204644 |
|---|---|
| Provider Enumeration Date | 03/25/2025 |
| Last Update Date | 05/06/2025 |
| Certification Date | 05/06/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962204644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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