Provider Demographics
NPI:1568446730
Name:STILLPASS, JAN CHERYL (LCSWC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:CHERYL
Last Name:STILLPASS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1057
Mailing Address - Country:US
Mailing Address - Phone:301-585-0470
Mailing Address - Fax:301-384-8111
Practice Address - Street 1:1107 SPRING ST
Practice Address - Street 2:STE A2
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4027
Practice Address - Country:US
Practice Address - Phone:301-585-0470
Practice Address - Fax:301-384-8111
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5299103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical