NPIMap

Organization Active NPI

Innersourced Solutions, Inc.

Doing business as InnerSourced Solutions LLC

  • Community/Behavioral Health Agency
  • Waldorf, MD
National Provider Identifier
1407314420
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
INNERSOURCED SOLUTIONS, INC.
Doing business as
InnerSourced Solutions LLC
Practice address
11705 Berry Rd Ste 104
Waldorf, MD 20603-5933
Phone
(240) 207-4513
Fax
(240) 846-6037
NPI assigned
Mar 8, 2019
Last updated
Apr 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michelle Dillard, DSW, LCSW-CNPI 1083988133
Title
Ceo
Phone
(240) 207-4513

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

11705 Berry Rd Ste 104
Waldorf, MD 20603-5933

Mailing address

11705 Berry Rd Ste 104
Waldorf, MD 20603-5933
Phone (240) 207-4513

Other names 1

  • InnerSourced Solutions LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Innersourced Solutions Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6755 Business Pkwy
Ste 306
Elkridge, MD 21075
Phone (240) 207-4513

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1407314420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11705 BERRY RD STE 104",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035933",
            "telephone_number": "240-207-4513",
            "fax_number": "240-846-6037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11705 BERRY RD STE 104",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035933",
            "telephone_number": "240-207-4513",
            "fax_number": "240-846-6037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERSOURCED SOLUTIONS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-08",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "DILLARD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-207-4513",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DSW, LCSW-C"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "InnerSourced Solutions LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.