Provider Demographics
NPI:1225454549
Name:STARKS, STEPHANIE K (LISW-S)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:STARKS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S 3RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5194
Mailing Address - Country:US
Mailing Address - Phone:614-484-0919
Mailing Address - Fax:614-484-0919
Practice Address - Street 1:175 S 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5194
Practice Address - Country:US
Practice Address - Phone:614-484-0919
Practice Address - Fax:614-484-7071
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1440100104100000X
OHI.1600116-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid