Provider Demographics
NPI:1629610035
Name:STAR CITY THERAPY SERVICES
Entity Type:Organization
Organization Name:STAR CITY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:540-206-2865
Mailing Address - Street 1:3618 BRAMBLETON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3659
Mailing Address - Country:US
Mailing Address - Phone:540-206-8265
Mailing Address - Fax:540-266-1735
Practice Address - Street 1:4220 CYPRESS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8403
Practice Address - Country:US
Practice Address - Phone:540-772-1872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health