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General NPI Number Information
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NPI Number | 1992401376
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Entity Type | Organization
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Legal Business Name | ELITE BEHAVIORAL THERAPY
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 09/16/2025
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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 | 240-403-7582
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Fax | 240-403-7629
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Provider Business Mailing Address
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Address Line | 11140 ROCKVILLE PIKE STE 480-E SUITE 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 | 240-408-7582
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Fax | 240-403-7629
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Authorized Official
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Title or Position | LCSW LICENSED PSYCHOTHERAPIST
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Name | DR. MIRTA ELVIRE INNIS-THOMPSON
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Credential | LCSW,LICSW,DSW
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Telephone | 202-763-9178
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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 |
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License Number State |
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