Basic Information
| Provider Information | |||||||||
| NPI: | 1558884338 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AFRICAN DIASPORA MENTAL HEALTH ASSOCIATION LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 STATE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011094114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132662207 | ||||||||
| FaxNumber: | 4133015164 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 STATE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011094114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132627414 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2017 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ALLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4132627414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | LICSW, LADC 1 | ||||||||
| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.