Provider Demographics
NPI:1780880112
Name:INFINITY COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:INFINITY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARUSI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:276-228-8775
Mailing Address - Street 1:320 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1009
Mailing Address - Country:US
Mailing Address - Phone:276-228-8775
Mailing Address - Fax:276-228-8776
Practice Address - Street 1:320 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1009
Practice Address - Country:US
Practice Address - Phone:276-228-8775
Practice Address - Fax:276-228-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty