| Affinity Clinical Services, Pllc | |
|
5500 Executive Center Drive Suite 118 Charlotte NC 28212 | |
| (980) 224-8060 | |
| (704) 379-1914 |
| Full Name | Affinity Clinical Services, Pllc |
|---|---|
| Speciality | Supports Brokerage |
| Location | 5500 Executive Center Drive, Charlotte, North Carolina |
| Authorized Official Name and Position | Samuel Ndupu (CLINICAL DIRECTOR, OWNER) |
| Authorized Official Contact | 9802248060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Affinity Clinical Services, Pllc 5500 Executive Center Drive Suite 118 Charlotte NC 28212 Ph: (980) 224-8060 | Affinity Clinical Services, Pllc 5500 Executive Center Drive Suite 118 Charlotte NC 28212 Ph: (980) 224-8060 |
| NPI Number | 1790219871 |
|---|---|
| Provider Enumeration Date | 04/17/2017 |
| Last Update Date | 06/19/2023 |
| Certification Date | 06/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790219871 | NPI | - | NPPES |
| 6103653 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 4936 (North Carolina) | Secondary |
| 251X00000X | Supports Brokerage | (* (Not Available)) | Primary |
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