Healthcare Provider Details

I. General information

NPI: 1245771567
Provider Name (Legal Business Name): STARLIGHT CHILD AND FAMILY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N FREDERICK AVE SUITE 300
GAITHERSBURG MD
20877-2507
US

IV. Provider business mailing address

501 N. FREDERICK AVE. STE. 300
GAITHERSBURG MD
20877
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-9838
  • Fax:
Mailing address:
  • Phone: 301-624-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15140
License Number StateMD

VIII. Authorized Official

Name: JULIA CHURCHILL
Title or Position: CHILD THERAPIST
Credential: LCSW-C, RPT
Phone: 301-624-9838