Provider Demographics
NPI:1437456795
Name:HENDRIX, STARLA ELIZABETH
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:ELIZABETH
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2552
Mailing Address - Country:US
Mailing Address - Phone:909-461-7350
Mailing Address - Fax:
Practice Address - Street 1:325 W HOSPITALITY LN STE 103
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3210
Practice Address - Country:US
Practice Address - Phone:951-653-0819
Practice Address - Fax:951-656-2614
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1344531041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician