Provider Demographics
NPI:1538343793
Name:AFOG, INC.
Entity type:Organization
Organization Name:AFOG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:YORKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:951-272-7032
Mailing Address - Street 1:31805 US HWY 79 SOUTH, PMB 227
Mailing Address - Street 2:PMB 227
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-272-7032
Mailing Address - Fax:951-676-8281
Practice Address - Street 1:42145 LYNDIE LN
Practice Address - Street 2:SUITE 108
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3612
Practice Address - Country:US
Practice Address - Phone:951-272-7032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty