MEDICARE: STARKEWOOD CHRISTIAN COUNSELING SERVICES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	0701003843	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295983914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARKEWOOD CHRISTIAN COUNSELING SERVICES, P.C.

Provider Business Mailing Address
First Line	:	1742 BERKELEY AVE
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2806
Country	:	US
Telephone Number	:	804-733-8585
Fax Number	:	804-733-9066

Provider Business Practice Location Address
First Line	:	589 S CRATER RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5263
Country	:	US
Telephone Number	:	804-733-8585
Fax Number	:	804-733-9066

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. LAWRENCE C STARKE II
Credential	:	LPC
Telephone Number	:	804-733-8585

Provider Enumeration Date	:	09/06/2008
Last Update Date	:	09/06/2008

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