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General NPI Number Information
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NPI Number | 1609245539
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Entity Type | Individual
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Provider Name | CORI STARR
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Gender | Female
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 43740 N GROESBECK HWY
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-1139
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Country | US
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Telephone | 586-469-7629
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Fax |
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Provider Business Mailing Address
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Address Line | 26359 BARRINGTON ST
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3549
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Country | US
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Telephone | 248-434-7459
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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 | 6801098130
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License Number State | MI
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