Innovative State of Mind LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INNOVATIVE STATE OF MIND LLC

Practice address

116 Baptist St
Salisbury, MD 21801-4911

Phone

(240) 486-0694

NPI assigned

Jan 27, 2020

Last updated

Jan 27, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Theresa M Huffines, LCSW-CNPI 1588058663

Title

Sole Owner

Phone

(240) 486-0694

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, FL2 enrollments

Enrollment records 2

Locations

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.

• Theresa Huffines, LCSW-C

  • Clinical Social Worker
  • Salisbury, MD
  • NPI 1588058663

  FL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1881225167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 S SALISBURY BLVD STE 8",
            "address_2": "#274",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218016865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 BAPTIST ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218014911",
            "telephone_number": "240-486-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE STATE OF MIND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-27",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "HUFFINES",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "240-486-0694",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.