Provider Demographics
NPI:1407314420
Name:INNERSOURCED SOLUTIONS, INC.
Entity Type:Organization
Organization Name:INNERSOURCED SOLUTIONS, INC.
Other - Org Name:INNERSOURCED SOLUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW-C
Authorized Official - Phone:240-207-4513
Mailing Address - Street 1:11705 BERRY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5933
Mailing Address - Country:US
Mailing Address - Phone:240-207-4513
Mailing Address - Fax:240-846-6037
Practice Address - Street 1:11705 BERRY RD STE 104
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5933
Practice Address - Country:US
Practice Address - Phone:240-207-4513
Practice Address - Fax:240-846-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)