Provider Demographics
NPI:1710461223
Name:STARKS, LAMONICA P (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LAMONICA
Middle Name:P
Last Name:STARKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:LAMONICA
Other - Middle Name:P
Other - Last Name:STARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:242 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9666
Mailing Address - Country:US
Mailing Address - Phone:601-812-8991
Mailing Address - Fax:
Practice Address - Street 1:118 WEISENBERGER RD STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5012
Practice Address - Country:US
Practice Address - Phone:601-812-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2382225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist