Provider Demographics
NPI:1245771567
Name:STARLIGHT CHILD AND FAMILY COUNSELING, LLC
Entity type:Organization
Organization Name:STARLIGHT CHILD AND FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, RPT
Authorized Official - Phone:301-624-9838
Mailing Address - Street 1:501 N. FREDERICK AVE.
Mailing Address - Street 2:STE. 300
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877
Mailing Address - Country:US
Mailing Address - Phone:301-624-9838
Mailing Address - Fax:
Practice Address - Street 1:501 N FREDERICK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2507
Practice Address - Country:US
Practice Address - Phone:301-624-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty