1184035701 NPI number — INFINITY COUNSELING AND THERAPEUTIC SERVICES,LLC

Table of content: KATIE O'DONNELL MSW, LICSW (NPI 1588364236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184035701 NPI number — INFINITY COUNSELING AND THERAPEUTIC SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY COUNSELING AND THERAPEUTIC SERVICES,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184035701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9142 EDMONSTON CT
Provider Second Line Business Mailing Address:
APT 203
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-565-1784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9142 EDMONSTON CT
Provider Second Line Business Practice Location Address:
APT 203
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-565-1784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LYNN
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
443-627-3428

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LMFT 000080 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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