Affinity Clinical Services, PLLC

Primary specialty

Supports Brokerage AgencyTaxonomy code 251X00000X

Legal business name

AFFINITY CLINICAL SERVICES, PLLC

Practice address

5500 Executive Center Drive
Suite 118
Charlotte, NC 28212

Phone

(980) 224-8060

Fax

(704) 379-1914

NPI assigned

Apr 17, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel Ndupu, LCMHCS, CCS, LCASNPI 1538389275

Title

Clinical Director, Owner

Phone

(980) 224-8060

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel Ndupu, LPC, LCAS, CCS

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1538389275

  Professional

  NPD Authorized official
• Alexandra Paige Stone, MA

  • Professional Counselor
  • Charlotte, NC
  • NPI 1194321570

  Professional

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1790219871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 EXECUTIVE CENTER DRIVE",
            "address_2": "SUITE 118",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28212",
            "telephone_number": "980-224-8060",
            "fax_number": "704-379-1914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 EXECUTIVE CENTER DRIVE",
            "address_2": "SUITE 118",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28212",
            "telephone_number": "980-224-8060",
            "fax_number": "704-379-1914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5124 Monroe Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282057826",
            "country_code": "US",
            "telephone_number": "704-379-1960",
            "fax_number": "704-379-1914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AFFINITY CLINICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-17",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "NDUPU",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR, OWNER",
        "authorized_official_telephone_number": "980-224-8060",
        "authorized_official_credential": "LCMHCS, CCS, LCAS"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "4936",
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103653",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@affinityclinical.org",
            "affiliation": "N",
            "address_1": "5624 Executive Center Dr Ste 105",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282128868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Supports Brokerage Agency in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Supports Brokerage Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.