Provider Demographics
NPI:1093832180
Name:STTAR CENTER INC
Entity Type:Organization
Organization Name:STTAR CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:JEANNIE
Authorized Official - Last Name:DILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-290-6432
Mailing Address - Street 1:9810 PATUXENT WOODS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1595
Mailing Address - Country:US
Mailing Address - Phone:410-290-6432
Mailing Address - Fax:410-290-6604
Practice Address - Street 1:9810 PATUXENT WOODS DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1595
Practice Address - Country:US
Practice Address - Phone:410-290-6432
Practice Address - Fax:410-290-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKK48THOtherCAREFIRST BCBS OF MD
MD4609758OtherAETNA
MD554418000OtherMAGELLAN BEHAVIORAL HEALT
MD447531300Medicaid
MD4609758OtherAETNA
MD=========OtherUNITED BEHAVIORAL HEALTH
MD447531300Medicaid