Provider Demographics
NPI:1659859486
Name:INFINITE HEALTH WELLNESS LLC
Entity Type:Organization
Organization Name:INFINITE HEALTH WELLNESS LLC
Other - Org Name:INFINITE HEALTH WELLNESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, CFO, COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:478-284-9587
Mailing Address - Street 1:2009 HIWASSEE DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-2509
Mailing Address - Country:US
Mailing Address - Phone:478-284-9587
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE POINTE STE 106
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3439
Practice Address - Country:US
Practice Address - Phone:478-919-2454
Practice Address - Fax:478-919-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty