Provider Demographics
NPI:1730633652
Name:STARBUCK, KELLY MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:STARBUCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3609
Mailing Address - Country:US
Mailing Address - Phone:804-349-5401
Mailing Address - Fax:
Practice Address - Street 1:103 HARTH PL STE B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8107
Practice Address - Country:US
Practice Address - Phone:843-879-3520
Practice Address - Fax:843-879-2174
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006681101YM0800X
SC7198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health