Provider Demographics
NPI:1609832070
Name:STARKE, LAWRENCE CARLTON II (LPC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:CARLTON
Last Name:STARKE
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
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Mailing Address - Street 1:116 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-1710
Mailing Address - Country:US
Mailing Address - Phone:434-292-1104
Mailing Address - Fax:434-292-1134
Practice Address - Street 1:1742 BERKELEY AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2806
Practice Address - Country:US
Practice Address - Phone:804-733-4494
Practice Address - Fax:804-733-9066
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701003843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188470OtherANTHEM
VA087775MOtherSENTARA
VA010243696Medicaid