| Affect Therapeutics, Inc. | |
|
1202 Central Ave Sw Ste 19 Albuquerque NM 87102-2803 | |
| (845) 769-8758 | |
| Not Available |
| Full Name | Affect Therapeutics, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1202 Central Ave Sw Ste 19, Albuquerque, New Mexico |
| Authorized Official Name and Position | Karla Renee Mullings (DIRECTOR CLINICAL COMPLIANCE) |
| Authorized Official Contact | 3235222218 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affect Therapeutics, Inc. 520 Broadway Fl 4 New York NY 10012-4436 Ph: () - | Affect Therapeutics, Inc. 1202 Central Ave Sw Ste 19 Albuquerque NM 87102-2803 Ph: (845) 769-8758 |
| NPI Number | 1942948351 |
|---|---|
| Provider Enumeration Date | 05/25/2022 |
| Last Update Date | 05/25/2022 |
| Certification Date | 05/25/2022 |
| Medicare PECOS PAC ID | 4284071903 |
|---|---|
| Medicare Enrollment ID | O20240502000830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942948351 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Nonye Nwokoro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811544000 PECOS PAC ID: 0749618734 Enrollment ID: I20211110001199 |
| Provider Name | Kenyua Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669815478 PECOS PAC ID: 0941438998 Enrollment ID: I20230908002906 |
| Provider Name | Jason Williamson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649923905 PECOS PAC ID: 7911443973 Enrollment ID: I20240725003801 |
| Provider Name | Heather Youngs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922367812 PECOS PAC ID: 5991243511 Enrollment ID: I20240814002545 |
| Provider Name | Crystal A Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871279331 PECOS PAC ID: 1254863400 Enrollment ID: I20241014002422 |
| Provider Name | Allison Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134599269 PECOS PAC ID: 6709184815 Enrollment ID: I20241108001813 |
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