Healthcare Provider Details

I. General information

NPI: 1225986896
Provider Name (Legal Business Name): STAR THERAPEUTIC SERVICES & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 POST OFFICE RD
WALDORF MD
20602-2738
US

IV. Provider business mailing address

401 POST OFFICE RD STE 101
WALDORF MD
20602-2738
US

V. Phone/Fax

Practice location:
  • Phone: 301-818-2456
  • Fax:
Mailing address:
  • Phone: 301-818-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATEASHA JOHNSON
Title or Position: FOUNDER/CEO
Credential: LCSW-C, LICSW, LCSW
Phone: 301-818-2456