Provider Demographics
NPI:1992849046
Name:TAIT-STARNES, CAROLE ANN (MA)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANN
Last Name:TAIT-STARNES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 INVERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4801
Mailing Address - Country:US
Mailing Address - Phone:408-245-3206
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE H186
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3903
Practice Address - Country:US
Practice Address - Phone:408-720-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT3239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health