Provider Demographics
NPI:1306379011
Name:STARKS, HEIDI (LCSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:STARKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:213 HOSPITAL RD E
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2119
Mailing Address - Country:US
Mailing Address - Phone:601-663-1210
Mailing Address - Fax:601-663-1211
Practice Address - Street 1:213 HOSPITAL RD E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2119
Practice Address - Country:US
Practice Address - Phone:601-663-1210
Practice Address - Fax:601-663-1211
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC85561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC8556OtherMS LICENSE #