Healthcare Provider Details

I. General information

NPI: 1588547871
Provider Name (Legal Business Name): MENDAY KAY STARK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 HOUZE RD STE 225
ROSWELL GA
30076-5618
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 770-603-0123
  • Fax: 770-910-9919
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: