Healthcare Provider Details

I. General information

NPI: 1528829181
Provider Name (Legal Business Name): NATHAN ALEXANDER SANDERS THOMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 PICCARD DR STE 110
ROCKVILLE MD
20850-4364
US

IV. Provider business mailing address

11714 VIRGINIA PINE DR
GERMANTOWN MD
20876-4303
US

V. Phone/Fax

Practice location:
  • Phone: 301-769-5878
  • Fax:
Mailing address:
  • Phone: 410-925-9845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: