Provider Demographics
NPI:1083184436
Name:HUCKEBA, STARLA RACHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:STARLA
Middle Name:RACHELLE
Last Name:HUCKEBA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:STARLA
Other - Middle Name:RACHELLE
Other - Last Name:SCHROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1416 NATCHITOCHES ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-3751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1416 NATCHITOCHES ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-3751
Practice Address - Country:US
Practice Address - Phone:318-855-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1627101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty