Provider Demographics
NPI:1871794115
Name:STARKS, KIRBY MIKELLE
Entity type:Individual
Prefix:
First Name:KIRBY
Middle Name:MIKELLE
Last Name:STARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MAPLE ST APT 107
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-6301
Mailing Address - Country:US
Mailing Address - Phone:678-360-3524
Mailing Address - Fax:
Practice Address - Street 1:1200 NOBLE ST # 1
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4659
Practice Address - Country:US
Practice Address - Phone:256-741-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor