Healthcare Provider Details

I. General information

NPI: 1619333093
Provider Name (Legal Business Name): INFINITY BEHAVIORAL AND DEVELOPMENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 WALLACE RD SUITE 100
CHARLOTTE NC
28212-6815
US

IV. Provider business mailing address

7003 WALLACE RD SUITE 100
CHARLOTTE NC
28212-6815
US

V. Phone/Fax

Practice location:
  • Phone: 919-685-5996
  • Fax:
Mailing address:
  • Phone: 919-685-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PEARL LAVERN GRIFFIN
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LCASA
Phone: 919-685-5996