Healthcare Provider Details

I. General information

NPI: 1184130817
Provider Name (Legal Business Name): DANA STARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 HOOVER RD
GROVE CITY OH
43123-9122
US

IV. Provider business mailing address

2612 PRENDERGAST PL
REYNOLDSBURG OH
43068-5207
US

V. Phone/Fax

Practice location:
  • Phone: 614-875-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801579
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0901511
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: