Provider Demographics
NPI:1457894834
Name:STARBIRD, LAURA CASEY (CADC-L CICA01610719)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:CASEY
Last Name:STARBIRD
Suffix:
Gender:F
Credentials:CADC-L CICA01610719
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4187 ETA ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-4349
Mailing Address - Country:US
Mailing Address - Phone:619-340-6126
Mailing Address - Fax:
Practice Address - Street 1:2970 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3296
Practice Address - Country:US
Practice Address - Phone:619-236-9492
Practice Address - Fax:619-232-0855
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACICA01610719101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831235837Medicaid
CACICA01610719Medicaid