| Affect Therapeutics | |
|
1640 Boro Pl Fl 4 Mc Lean VA 22102-3627 | |
| (845) 769-8758 | |
| Not Available |
| Full Name | Affect Therapeutics |
|---|---|
| Speciality | Clinic/Center |
| Location | 1640 Boro Pl Fl 4, Mc Lean, Virginia |
| Authorized Official Name and Position | Karla Renee Mullings (DIRECTOR OF 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 1640 Boro Pl Fl 4 Mc Lean VA 22102-3627 Ph: (845) 769-8758 | Affect Therapeutics 1640 Boro Pl Fl 4 Mc Lean VA 22102-3627 Ph: (845) 769-8758 |
| NPI Number | 1104402064 |
|---|---|
| Provider Enumeration Date | 03/22/2021 |
| Last Update Date | 04/11/2023 |
| Certification Date | 04/11/2023 |
| Medicare PECOS PAC ID | 4284071903 |
|---|---|
| Medicare Enrollment ID | O20240318001200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104402064 | NPI | - | NPPES |
| Provider Name | Kenyua Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669815478 PECOS PAC ID: 0941438998 Enrollment ID: I20170918001058 |
| Provider Name | Nonye Frances Nwokoro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811544000 PECOS PAC ID: 0749618734 Enrollment ID: I20200325003638 |
| Provider Name | Tessie Eberhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992322168 PECOS PAC ID: 6507284304 Enrollment ID: I20200918000145 |
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