Healthcare Provider Details

I. General information

NPI: 1932705209
Provider Name (Legal Business Name): INFINITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9056 FOX STREAM WAY
UPPER MARLBORO MD
20772-2556
US

IV. Provider business mailing address

9056 FOX STREAM WAY
UPPER MARLBORO MD
20772-2556
US

V. Phone/Fax

Practice location:
  • Phone: 202-843-7622
  • Fax: 240-306-1219
Mailing address:
  • Phone: 202-843-7622
  • Fax: 240-306-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WHITE
Title or Position: FOUNDER
Credential: LICSW, LCSW-C
Phone: 301-706-2374