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General NPI Number Information
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NPI Number | 1093832180
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Entity Type | Organization
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Legal Business Name | STTAR CENTER INC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 9810 PATUXENT WOODS DR SUITE C
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City | COLUMBIA
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State | MD
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Zip | 21046-1595
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Country | US
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Telephone | 410-290-6432
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Fax | 410-290-6604
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Provider Business Mailing Address
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Address Line | 9810 PATUXENT WOODS DR SUITE C
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City | COLUMBIA
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State | MD
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Zip | 21046-1595
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Country | US
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Telephone | 410-290-6432
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Fax | 410-290-6604
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LORETTA JEANNIE DILLINGHAM
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Credential |
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Telephone | 410-290-6432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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