Healthcare Provider Details

I. General information

NPI: 1386940740
Provider Name (Legal Business Name): ELIZABETH MCLANAHAN STARK MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 M ST NW SUITE 712
WASHINGTON DC
20037-1434
US

IV. Provider business mailing address

1620 CORCORAN ST NW APT E
WASHINGTON DC
20009-3032
US

V. Phone/Fax

Practice location:
  • Phone: 202-677-6186
  • Fax:
Mailing address:
  • Phone: 559-681-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: