Healthcare Provider Details

I. General information

NPI: 1700706686
Provider Name (Legal Business Name): JANAE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD STE U3
BERWYN HEIGHTS MD
20740-2361
US

IV. Provider business mailing address

6201 GREENBELT RD STE U3
BERWYN HEIGHTS MD
20740-2361
US

V. Phone/Fax

Practice location:
  • Phone: 301-747-7038
  • Fax:
Mailing address:
  • Phone: 301-747-7038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADT2739
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: