Healthcare Provider Details

I. General information

NPI: 1841194669
Provider Name (Legal Business Name): STARTACIA PACK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 MURRAY AVE STE 204
MEMPHIS TN
38119-3898
US

IV. Provider business mailing address

5545 MURRAY AVE STE 204
MEMPHIS TN
38119-3898
US

V. Phone/Fax

Practice location:
  • Phone: 901-625-3637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: