Provider Demographics
NPI:1447739347
Name:STARLING, WENDELL CHRISTOPHER I
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:CHRISTOPHER
Last Name:STARLING
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ARMORLITE DR APT 120
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-1397
Mailing Address - Country:US
Mailing Address - Phone:760-208-8105
Mailing Address - Fax:
Practice Address - Street 1:1215 ARMORLITE DR APT 120
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1397
Practice Address - Country:US
Practice Address - Phone:760-208-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CARBT-15-02130106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician