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General NPI Number Information
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NPI Number | 1821515008
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Entity Type | Organization
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Legal Business Name | INFINITE GROWTH LIFE AND WELLNESS LLC
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 11/14/2020
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Provider Practice Location Address
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Address Line | 6600 YORK RD STE 109A
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City | BALTIMORE
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State | MD
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Zip | 21212-2092
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Country | US
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Telephone | 443-848-4335
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Fax |
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Provider Business Mailing Address
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Address Line | P.O BOX 31730
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City | GWYNN OAK
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State | MD
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Zip | 21207-9998
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Country | US
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Telephone | 443-848-4335
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. TYVANGELA CHRISTINE HOPKINS
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Credential | LCSW-C
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Telephone | 443-848-4335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20031
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License Number State | MD
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