1811485212 NPI number — INFINITY COUNSELING AND THERAPEUTIC SERVICES LLC

Table of content: (NPI 1811485212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811485212 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:
1811485212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 401251
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48240-9251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-719-1555
Provider Business Mailing Address Fax Number:
833-709-0813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15900 W 10 MILE RD
Provider Second Line Business Practice Location Address:
PMB 4032 SUITE 211
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-2079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-719-1555
Provider Business Practice Location Address Fax Number:
833-709-0813
Provider Enumeration Date:
05/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RILEY
Authorized Official First Name:
NATHIFA
Authorized Official Middle Name:
GRACE MKATE
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
734-719-1555

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  68001091914 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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