Provider Demographics
NPI:1619740354
Name:STARLIGHT COUNSELING LLC
Entity Type:Organization
Organization Name:STARLIGHT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAUGHERTY-DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CISW, LICSW
Authorized Official - Phone:608-316-5687
Mailing Address - Street 1:1101 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2727
Mailing Address - Country:US
Mailing Address - Phone:608-316-5687
Mailing Address - Fax:
Practice Address - Street 1:2000 ENGEL ST STE 201
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4822
Practice Address - Country:US
Practice Address - Phone:608-316-5687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)