Provider Demographics
NPI:1669795787
Name:CHILTON, STAR MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:STAR
Middle Name:MARIE
Last Name:CHILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3409
Mailing Address - Country:US
Mailing Address - Phone:336-617-8910
Mailing Address - Fax:336-617-8909
Practice Address - Street 1:1211 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4537
Practice Address - Country:US
Practice Address - Phone:336-328-1111
Practice Address - Fax:336-328-1112
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005589101Y00000X
NCC0076571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor