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General NPI Number Information
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NPI Number | 1245771567
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Entity Type | Organization
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Legal Business Name | STARLIGHT CHILD AND FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 06/06/2017
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Provider Practice Location Address
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Address Line | 501 N FREDERICK AVE SUITE 300
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2507
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Country | US
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Telephone | 301-624-9838
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Fax |
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Provider Business Mailing Address
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Address Line | 501 N. FREDERICK AVE. STE. 300
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City | GAITHERSBURG
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State | MD
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Zip | 20877
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Country | US
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Telephone | 301-624-9838
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Fax |
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Authorized Official
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Title or Position | CHILD THERAPIST
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Name | JULIA CHURCHILL
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Credential | LCSW-C, RPT
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Telephone | 301-624-9838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15140
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License Number State | MD
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