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General NPI Number Information
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NPI Number | 1144465097
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Entity Type | Individual
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Provider Name | STACEY CHRISTEN STARK LICSW, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 12/06/2008
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 96 HARRY S TRUMAN DR SUITE 250
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-1000
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Country | US
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Telephone | 301-324-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 8454 UPPER SKY WAY
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City | LAUREL
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State | MD
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Zip | 20723-5608
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Country | US
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Telephone | 301-466-3716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50080347
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27196
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License Number State | MD
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