Provider Demographics
NPI:1225424351
Name:STARK, NADINE MICHELLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:MICHELLE
Last Name:STARK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-1882
Mailing Address - Country:US
Mailing Address - Phone:231-499-0020
Mailing Address - Fax:
Practice Address - Street 1:800 COTTAGEVIEW DR STE 1072
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2322
Practice Address - Country:US
Practice Address - Phone:231-499-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68011064671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical