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General NPI Number Information
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NPI Number | 1386983393
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Entity Type | Individual
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Provider Name | MIRTA ELVIRE INNIS-THOMPSON LCSW-C,LICSW, DSW
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Gender | Female
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 11140 ROCKVILLE PIKE STE 480-E
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City | NORTH BETHESDA
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State | MD
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Zip | 20852-3106
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Country | US
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Telephone | 202-763-9178
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Fax | 240-403-7629
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Provider Business Mailing Address
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Address Line | 12529 GREY FOX LN
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City | POTOMAC
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State | MD
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Zip | 20854-1903
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Country | US
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Telephone | 202-763-9178
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Fax | 240-403-7582
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 200001933
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28198
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101906
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License Number State | CA
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