Affect Provider Group P.S.C.

Organization Active NPI Mental Health Counselor · Archdale, NC

NPI 1801788286 · NPPES record last updated Aug 14, 2026

Key facts

NPI
1801788286
Entity type
Organization (NPI type 2)
Primary specialty
Mental Health Counselor 101YM0800X
Legal business name
AFFECT PROVIDER GROUP P.S.C.
Practice address
313C Trindale Rd Ste 205
Archdale, NC 27263-2751
Phone
(845) 769-8758
NPI assigned
Jul 18, 2025
Organization subpart
No

Authorized official

Name
Karla Renee Mullings
Title
Director of Compliance
Phone
(845) 768-8758

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 22

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20240507001406 NC Part B Supplier - Clinic/Group Practice 5597105684 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Archdale, NC

National Provider Directory

Tax ID family
Affect (23 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor
Group: 193200000X MULTI-SPECIALTY GROUP
101YM0800X Yes
Clinical Psychologist
Group: 193200000X MULTI-SPECIALTY GROUP
103TC0700X
Clinical Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP
1041C0700X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Group: 193200000X MULTI-SPECIALTY GROUP
364SP0809X

Addresses

Primary practice location

313C Trindale Rd Ste 205
Archdale, NC 27263-2751

Mailing address

PO Box 96635
Phoenix, AZ 85072-6635
Phone (845) 769-8758

Other providers in Archdale, NC

All providers in Archdale, NC · Mental Health Counselor in North Carolina

Sources for this page

Verify at the official NPI Registry.