Provider Demographics
NPI:1427761386
Name:STARKES, DONTAE
Entity type:Individual
Prefix:
First Name:DONTAE
Middle Name:
Last Name:STARKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 175TH ST STE 3NW
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2057
Mailing Address - Country:US
Mailing Address - Phone:773-998-9948
Mailing Address - Fax:
Practice Address - Street 1:1935 E 173RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3735
Practice Address - Country:US
Practice Address - Phone:773-647-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health