Healthcare Provider Details

I. General information

NPI: 1710694898
Provider Name (Legal Business Name): REACHING INFINITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 RIDGE RD
FREDERICK MD
21702-3509
US

IV. Provider business mailing address

7015 RIDGE RD
FREDERICK MD
21702-3509
US

V. Phone/Fax

Practice location:
  • Phone: 240-446-2363
  • Fax:
Mailing address:
  • Phone: 240-446-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY WILLIAM MEADORS
Title or Position: OWNER
Credential: LCSW-C
Phone: 240-446-2363