Provider Demographics
NPI:1609948108
Name:STARKS, GAIL ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANN
Last Name:STARKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20300 CIVIC CENTER DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4169
Mailing Address - Country:US
Mailing Address - Phone:248-559-8190
Mailing Address - Fax:248-559-8776
Practice Address - Street 1:200 DIVERSION STREET
Practice Address - Street 2:SUITE 10A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2273
Practice Address - Country:US
Practice Address - Phone:248-608-9740
Practice Address - Fax:248-608-9752
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003908103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN90430002Medicare ID - Type Unspecified