Provider Demographics
NPI:1083007959
Name:STARK, ANN MARIE (MA, LPCC/LPC, LAC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:STARK
Suffix:
Gender:F
Credentials:MA, LPCC/LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7324
Mailing Address - Country:US
Mailing Address - Phone:757-802-4500
Mailing Address - Fax:
Practice Address - Street 1:770 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7324
Practice Address - Country:US
Practice Address - Phone:757-802-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1544101YA0400X
VA0718000251101YA0400X
ND550-2-15-06-196101YM0800X
VA0701005841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)