Individual ProviderMirta Elvire Innis-ThompsonSocial WorkerBehavioral Health & Social Service ProvidersPractice Address11140 Rockville Pike Ste 480-E, North Bethesda, MD 20852-3106(202) 763-9178PECOS EnrollmentBased on the most recent information from CMS, provider Mirta Elvire Innis-Thompson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1386983393Provider TypeIndividualFull NameInnis-Thompson, Mirta ElvireCredentialLCSW-C,LICSW, DSWGenderFemaleSole ProprietorYesEnumeration Date2/11/2013Last Updated8/25/2025Contact InformationPractice LocationPractice Address11140 Rockville Pike Ste 480-E, North Bethesda, MD 20852-3106Phone(202) 763-9178Fax(240) 403-7629Mailing LocationMailing Address12529 Grey Fox Ln, Potomac, MD 20854-1903Phone(202) 763-9178Fax(240) 403-7582Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense28198MarylandCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense200001933District of ColumbiaCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense101906California