Provider Demographics
NPI:1821515008
Name:INFINITE GROWTH LIFE AND WELLNESS LLC
Entity Type:Organization
Organization Name:INFINITE GROWTH LIFE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TYVANGELA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-848-4335
Mailing Address - Street 1:P.O BOX 31730
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-9998
Mailing Address - Country:US
Mailing Address - Phone:443-848-4335
Mailing Address - Fax:
Practice Address - Street 1:6600 YORK RD STE 109A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2092
Practice Address - Country:US
Practice Address - Phone:443-848-4335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty