Provider Demographics
NPI:1144465097
Name:STARK, STACEY CHRISTEN (LICSW, LCSW-C)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:CHRISTEN
Last Name:STARK
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8454 UPPER SKY WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5608
Mailing Address - Country:US
Mailing Address - Phone:301-466-3716
Mailing Address - Fax:
Practice Address - Street 1:96 HARRY S TRUMAN DR
Practice Address - Street 2:SUITE 250
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1000
Practice Address - Country:US
Practice Address - Phone:301-324-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-06
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500803471041C0700X
MD271961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical