Provider Demographics
NPI:1972202117
Name:INFINITE WELLNESS MARYLAND
Entity Type:Organization
Organization Name:INFINITE WELLNESS MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-306-5678
Mailing Address - Street 1:8843 GREENBELT RD STE 312
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2451
Mailing Address - Country:US
Mailing Address - Phone:443-306-5678
Mailing Address - Fax:
Practice Address - Street 1:8843 GREENBELT RD STE 312
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2451
Practice Address - Country:US
Practice Address - Phone:443-306-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23560OtherSOCIAL WORKER LICENSE