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General NPI Number Information
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NPI Number | 1669795787
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Entity Type | Individual
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Provider Name | STAR MARIE CHILTON LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 1211 N FAYETTEVILLE ST
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City | ASHEBORO
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State | NC
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Zip | 27203-4537
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Country | US
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Telephone | 336-328-1111
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Fax | 336-328-1112
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Provider Business Mailing Address
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Address Line | 2211 W MEADOWVIEW RD SUITE 10
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City | GREENSBORO
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State | NC
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Zip | 27407-3409
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Country | US
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Telephone | 336-617-8910
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Fax | 336-617-8909
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P005589
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License Number State | NC
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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 | C007657
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License Number State | NC
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