Provider Demographics
NPI:1285271791
Name:STARR, CARLA (LCSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:OGLALA
Mailing Address - State:SD
Mailing Address - Zip Code:57764-0568
Mailing Address - Country:US
Mailing Address - Phone:716-864-4726
Mailing Address - Fax:
Practice Address - Street 1:963 LONEMAN CT
Practice Address - Street 2:
Practice Address - City:OGLALA
Practice Address - State:SD
Practice Address - Zip Code:57764-3076
Practice Address - Country:US
Practice Address - Phone:716-864-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2023-04-21
Deactivation Date:2022-04-04
Deactivation Code:
Reactivation Date:2022-07-13
Provider Licenses
StateLicense IDTaxonomies
104100000X
SD52421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker