Provider Demographics
NPI:1295983914
Name:STARKEWOOD CHRISTIAN COUNSELING SERVICES, P.C.
Entity type:Organization
Organization Name:STARKEWOOD CHRISTIAN COUNSELING SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:STARKE
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-733-8585
Mailing Address - Street 1:1742 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2806
Mailing Address - Country:US
Mailing Address - Phone:804-733-8585
Mailing Address - Fax:804-733-9066
Practice Address - Street 1:589 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5263
Practice Address - Country:US
Practice Address - Phone:804-733-8585
Practice Address - Fax:804-733-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003843251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010243696Medicaid
VA010336449Medicaid