Provider Demographics
NPI:1811485212
Name:INFINITY COUNSELING AND THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:INFINITY COUNSELING AND THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NATHIFA
Authorized Official - Middle Name:GRACE MKATE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-719-1555
Mailing Address - Street 1:PO BOX 401251
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-9251
Mailing Address - Country:US
Mailing Address - Phone:734-719-1555
Mailing Address - Fax:
Practice Address - Street 1:26150 5 MILE RD STE 33
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3240
Practice Address - Country:US
Practice Address - Phone:734-719-1555
Practice Address - Fax:313-286-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68001091914261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)