Provider Demographics
NPI:1285290353
Name:AFFINITY THERAPY SERVICES
Entity type:Organization
Organization Name:AFFINITY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EBONE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA-DWIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-776-9408
Mailing Address - Street 1:4286 RAEFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3247
Mailing Address - Country:US
Mailing Address - Phone:410-776-9408
Mailing Address - Fax:
Practice Address - Street 1:4286 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3247
Practice Address - Country:US
Practice Address - Phone:910-849-2959
Practice Address - Fax:910-676-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty