Provider Demographics
NPI:1780159095
Name:AFFIRM WELLNESS
Entity type:Organization
Organization Name:AFFIRM WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/SERVICE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DESHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-580-3992
Mailing Address - Street 1:5036 SNAPFINGER WOODS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4039
Mailing Address - Country:US
Mailing Address - Phone:770-580-3992
Mailing Address - Fax:
Practice Address - Street 1:5036 SNAPFINGER WOODS DR STE 201
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4039
Practice Address - Country:US
Practice Address - Phone:770-580-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty