MEDICARE: INFINITY COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	LPC008852	GA

General Provider Information

NPI Number	:	1710341011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY COUNSELING LLC

Provider Business Mailing Address
First Line	:	2420 WOOD MEADOWS DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4471
Country	:	US
Telephone Number	:	678-933-6526
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 WOOD MEADOWS DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4471
Country	:	US
Telephone Number	:	678-933-6526
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLETTE CHAIN CULBREATH
Credential	:	MA, LPC
Telephone Number	:	678-933-6526

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	04/12/2016

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