MEDICARE: STAR THERAPEUTIC SERVICES & CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1225986896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR THERAPEUTIC SERVICES & CONSULTING LLC

Provider Business Mailing Address
First Line	:	401 POST OFFICE RD STE 101
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2738
Country	:	US
Telephone Number	:	301-818-2456
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 POST OFFICE RD
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2738
Country	:	US
Telephone Number	:	301-818-2456
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	LATEASHA JOHNSON
Credential	:	LCSW-C, LICSW, LCSW
Telephone Number	:	301-818-2456

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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