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General NPI Number Information
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NPI Number | 1053032268
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Entity Type | Organization
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Legal Business Name | INFINITY BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 107 UPPER RIVERDALE RD SW
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City | RIVERDALE
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State | GA
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Zip | 30274-2504
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Country | US
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Telephone | 770-450-5467
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Fax |
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Provider Business Mailing Address
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Address Line | 6317 REDAN SQ
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City | LITHONIA
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State | GA
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Zip | 30058-7105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAYLA CLARK
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Credential | BCBA
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Telephone | 678-481-2390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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