Healthcare Provider Details

I. General information

NPI: 1841133899
Provider Name (Legal Business Name): ELIJAH THOMAS III LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BESTGATE RD STE 300
ANNAPOLIS MD
21401-7957
US

IV. Provider business mailing address

1379 9TH CT
WEST PALM BEACH FL
33401-3146
US

V. Phone/Fax

Practice location:
  • Phone: 410-881-2232
  • Fax:
Mailing address:
  • Phone: 561-584-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26153
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: