Provider Demographics
NPI:1619333093
Name:INFINITY BEHAVIORAL AND DEVELOPMENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:INFINITY BEHAVIORAL AND DEVELOPMENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCASA
Authorized Official - Phone:919-685-5996
Mailing Address - Street 1:7003 WALLACE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-6815
Mailing Address - Country:US
Mailing Address - Phone:919-685-5996
Mailing Address - Fax:
Practice Address - Street 1:7003 WALLACE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6815
Practice Address - Country:US
Practice Address - Phone:919-685-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty