Provider Demographics
NPI:1114042389
Name:STARK, SHARON E (LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:STARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 LAKESIDE PARK
Mailing Address - Street 2:LAKESIDE OFFICE PARK
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4078
Mailing Address - Country:US
Mailing Address - Phone:215-354-0777
Mailing Address - Fax:
Practice Address - Street 1:504 LAKESIDE PARK
Practice Address - Street 2:LAKESIDE OFFICE PARK
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4078
Practice Address - Country:US
Practice Address - Phone:215-354-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health