{
  "npi": "1104402064",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "CADC lll",
    "authorized_official_first_name": "KARLA",
    "authorized_official_last_name": "MULLINGS",
    "authorized_official_middle_name": "RENEE",
    "authorized_official_telephone_number": "3235222218",
    "authorized_official_title_or_position": "Director of Compliance",
    "certification_date": "2026-08-20",
    "enumeration_date": "2021-03-22",
    "last_updated": "2026-08-20",
    "organization_name": "AFFECT THERAPEUTICS INC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 96634",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "PHOENIX",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "850726634",
      "state": "AZ",
      "telephone_number": "845-769-8758"
    },
    {
      "address_1": "1001 RESEARCH PARK BLVD STE 100",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "CHARLOTTESVILLE",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "229115848",
      "state": "VA",
      "telephone_number": "845-769-8758"
    }
  ],
  "taxonomies": [
    {
      "code": "101YA0400X",
      "desc": "Counselor, Addiction (Substance Use Disorder)",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "101YP2500X",
      "desc": "Counselor, Professional",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "1041C0700X",
      "desc": "Social Worker, Clinical",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "163W00000X",
      "desc": "Registered Nurse",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "2084A0401X",
      "desc": "Psychiatry & Neurology, Addiction Medicine",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "261QC1500X",
      "desc": "Clinic/Center, Community Health",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QM0801X",
      "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QM0850X",
      "desc": "Clinic/Center, Adult Mental Health",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QR0405X",
      "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "363LC1500X",
      "desc": "Nurse Practitioner, Community Health",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "363LP0808X",
      "desc": "Nurse Practitioner, Psych/Mental Health",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center",
    "certifying_board": "Accreditation Association for Ambulatory Health Care (AAAHC) / CMS",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "D5",
        "medicare_type": "Opioid Treatment Program"
      }
    ]
  }
}