Provider Demographics
NPI:1518089770
Name:THIEL, MINDY (LCSWC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:THIEL
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 HAMPTON MILL TER APT 100
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5450
Mailing Address - Country:US
Mailing Address - Phone:301-231-9001
Mailing Address - Fax:301-231-0124
Practice Address - Street 1:4701 RANDOLPH RD STE G8
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2259
Practice Address - Country:US
Practice Address - Phone:301-231-9001
Practice Address - Fax:301-231-0124
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical