Healthcare Provider Details

I. General information

NPI: 1679839799
Provider Name (Legal Business Name): JEFFREY D STARK B.A., M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 WILSON RD
WILMINGTON DE
19803-3449
US

IV. Provider business mailing address

1006 WILSON RD
WILMINGTON DE
19803-3449
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-3848
  • Fax: 215-836-4929
Mailing address:
  • Phone: 302-478-3848
  • Fax: 215-836-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: