Provider Demographics
NPI:1548970338
Name:AFFIRMING SUPPORT COLLABORATIVE LLC
Entity type:Organization
Organization Name:AFFIRMING SUPPORT COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAILEY
Authorized Official - Middle Name:MARCE
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:347-853-9220
Mailing Address - Street 1:10535 ROSE AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4647
Mailing Address - Country:US
Mailing Address - Phone:347-853-9220
Mailing Address - Fax:
Practice Address - Street 1:10535 ROSE AVE APT 10
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4647
Practice Address - Country:US
Practice Address - Phone:347-853-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty