Affect Therapeutics Inc
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Charlottesville, VA
NPI 1104402064 · NPPES record last updated Aug 20, 2026
Key facts
- NPI
- 1104402064
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- AFFECT THERAPEUTICS INC
- Practice address
- 1001 Research Park Blvd Ste 100
Charlottesville, VA 22911-5848 - Phone
- (845) 769-8758
- NPI assigned
- Mar 22, 2021
- Organization subpart
- No
Authorized official
- Name
- Karla Renee Mullings, CADC LLL
- Title
- Director of Compliance
- Phone
- (323) 522-2218
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Practitioners 53
-
Cynthia Awadzi, FNP
-
Jennifer Gardner, LPC, NCC
-
Jennifer Anne Alexander, FNP PMHNP
-
Andrietta Wright Barnett, DNP FNP-C PMHNP-BC
-
Miranda Ann Bergman, LPCC, CADC
-
Lynn Marie Brown, LSW
-
Tia Denise Carrington, NP-C
-
Allison Carter, CRNP
-
Tracey Lynn Checo, CADCI
-
Anne Wayson Dalton, MSN, CRNP, PMHNP-BC
-
Tessie Leigh Eberhart, PMHNP-BC
-
Kelly Lynore Rosenthal Fink, PMHNP-BC, FNP-C
-
Mary Beth Frey, FNP
-
Brandy Renae Friemel, FNP
-
Lori Ann Gonzales, ACNP-BC, PMHNP-BC
-
Roshanda Grayson-Thomas, APRN
-
Tina Hacker, LICDC
-
Justin E Hampton, LCSW
-
Alison Holly, LCSW
-
Kenyua N Johnson, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2233019 | Affect Therapeutics, Inc | Certificate of waiver | Aug 18, 2027 |
| 26D2278541 | Affect Therapeutics, Inc | Certificate of waiver | Mar 19, 2027 |
| 29D2261583 | Affect Therapeutics, Inc | Certificate of waiver | Jul 11, 2027 |
| 45D2276212 | Affect Therapeutics, Inc | Certificate of waiver | Feb 5, 2027 |
| 50D2276741 | Affect Therapeutics Inc | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (13 enrollments) in TX, AZ, TN, IL, FL, NV, DC, WA, OH, CA, MO, IN, OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240318001200 | TX | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 12 practitioners Practice locations: Tyler, TX |
| O20240408000280 | AZ | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 12 practitioners Practice locations: Tucson, AZ |
| O20240411001956 | TN | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 2 practitioners Practice locations: Knoxville, TN |
| O20240415003852 | IL | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 1 practitioner Practice locations: Geneva, IL |
| O20240417002634 | FL | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 2 practitioners Practice locations: Jacksonville, FL |
| O20240515000221 | NV | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 7 practitioners Practice locations: Las Vegas, NV |
| O20240521002212 | DC | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 5 practitioners Practice locations: MC Lean, VA |
| O20240607001684 | WA | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 1 practitioner Practice locations: Vancouver, WA |
| O20241002001787 | OH | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 13 practitioners 1 other NPI on this enrollment Practice locations: Athens, OH |
| O20241125002675 | CA | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 4 practitioners Practice locations: Sacramento, CA |
| O20250819003456 | MO | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 5 practitioners Practice locations: Ballwin, MO; Saint Peters, MO |
| O20260130001699 | IN | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 1 practitioner Practice locations: Indianapolis, IN |
| O20260325000637 | OR | Part B Supplier - Clinic/Group Practice | 4284071903 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: King City, OR |
National Provider Directory
Locations
8880 E Speedway Blvd
Tucson, AZ 85710
6282 DuPont Station Ct E
Ste 1A
Jacksonville, FL 32217
116 N 3rd St
Ste 3
Danville, KY 40422
1202 Central Ave SW
Ste 19
Albuquerque, NM 87102
1001 Research Park Blvd
Ste 100
Charlottesville, VA 22911
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Professional Counselor |
101YP2500X | |||
| Clinical Social Worker |
1041C0700X | |||
| Registered Nurse |
163W00000X | |||
| Addiction Medicine (Psychiatry & Neurology) Physician |
2084A0401X | |||
| Community Health Clinic/Center | 261QC1500X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Adult Mental Health Clinic/Center | 261QM0850X | |||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes | ||
| Community Health Nurse Practitioner |
363LC1500X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
1001 Research Park Blvd Ste 100
Charlottesville, VA 22911-5848
Mailing address
PO Box 96634
Phoenix, AZ 85072-6634
Phone (845) 769-8758
Other practice location 1
507 Richland Ave Ste 105
Athens, OH 45701-3700
Phone (845) 769-8758
Other practice location 2
3800 Paluxy Dr Ste 404
Tyler, TX 75703-1617
Phone (845) 769-8758
Other practice location 3
8880 E Speedway Blvd Ste 203
Tucson, AZ 85710-1712
Phone (845) 769-8758
Other practice location 4
13975 Manchester Rd Ste 2
Ballwin, MO 63011-4500
Phone (845) 769-8758
Other practice location 5
863 Massachusetts Ave Ofc 220
Indianapolis, IN 46204-1610
Phone (845) 769-8758
Other practice location 6
1112 Daniels St Bsmt Suite
Vancouver, WA 98660-2954
Phone (845) 769-8758
Other practice location 7
15405 SW 116th Ave Ste 124
King City, OR 97224-4103
Phone (845) 769-8758
Other practice location 8
3550 Watt Ave Ste 140
Sacramento, CA 95821-2666
Phone (845) 769-8758
Other practice location 9
6282 DuPont Station Ct E Ofc A
Jacksonville, FL 32217-2515
Phone (845) 769-8758
Other practice location 10
1397 Galleria Dr Ste 203
Henderson, NV 89014-6659
Phone (845) 769-8758
Other names
- Affect Therapeutics
Other providers in Charlottesville, VA
- Advanced Dermatology of Charlottesville, PLC
- Advanced Mobile Wound Care of Virginia LLC
- Advanced Pain Management of Virginia LLC
- Advanced Practice Services, LLC
- Aesthetic Dentistry of Charlottesville, P.C.
- Affordable Dentures & Implants - Charlottesville, P.C.
- Samina Afreen
- Courtney Agamedi
- Garima Agarwal
- Elisha Agee
All providers in Charlottesville, VA · Substance Use Disorder Rehabilitation Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.