Provider Demographics
NPI:1437799533
Name:INNISS, ANN PATRICIA (LGP9886)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:PATRICIA
Last Name:INNISS
Suffix:
Gender:F
Credentials:LGP9886
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-1050
Mailing Address - Country:US
Mailing Address - Phone:301-542-6800
Mailing Address - Fax:301-609-6741
Practice Address - Street 1:816 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9470
Practice Address - Country:US
Practice Address - Phone:301-542-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health