Provider Demographics
NPI:1083944391
Name:INFINITE POSSIBILITIES COUNSELING SERVICE
Entity Type:Organization
Organization Name:INFINITE POSSIBILITIES COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-309-3137
Mailing Address - Street 1:924 GAINESVILLE HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1639
Mailing Address - Country:US
Mailing Address - Phone:770-309-3137
Mailing Address - Fax:770-831-3615
Practice Address - Street 1:924 GAINESVILLE HWY STE 210
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1639
Practice Address - Country:US
Practice Address - Phone:770-309-3137
Practice Address - Fax:770-831-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003041251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health