Provider Demographics
NPI:1285175950
Name:AFFINITY CHILD AND FAMILY SERVICES, INC
Entity type:Organization
Organization Name:AFFINITY CHILD AND FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:STILES-BRADSHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-318-7544
Mailing Address - Street 1:2030 E FLAMINGO RD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0831
Mailing Address - Country:US
Mailing Address - Phone:702-478-5527
Mailing Address - Fax:702-478-6012
Practice Address - Street 1:2030 E FLAMINGO RD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-478-5527
Practice Address - Fax:702-478-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161529992251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health