Provider Demographics
NPI:1033001656
Name:AFFECT PROVIDER GROUP P.S.C.
Entity type:Organization
Organization Name:AFFECT PROVIDER GROUP P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MULLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-768-8758
Mailing Address - Street 1:1640 BORO PL FL 4
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3627
Mailing Address - Country:US
Mailing Address - Phone:845-769-8758
Mailing Address - Fax:
Practice Address - Street 1:1640 BORO PL OFC 437
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3626
Practice Address - Country:US
Practice Address - Phone:845-769-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty