Doctor Name: | DAVID LEROY AFFOLTER |
NPI Number: | 1033388053 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | MH6268 |
Business Practice Address: | 570 Memorial Cir Suite 150 Ormond Beach, FL - 321745002 |
Business Phone Number: | 3867931346 |
Business Fax Number: | 3864923640 |
Mailing Address: | 570 Memorial Cir, Suite 150 ORMOND BEACH |
State: | FL |
Postal Code: | 321745002 |
Phone Number: | 3867931346 |
Fax Number: | 3864923640 |
NPI Enumeration Date: | 02/23/2008 |
NPI Last Update Date: | 02/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH6268 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |