Provider Demographics
NPI:1588547871
Name:STARK, MENDAY KAY (APC)
Entity type:Individual
Prefix:
First Name:MENDAY
Middle Name:KAY
Last Name:STARK
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CHATTAHOOCHEE WINDS DR
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-3208
Mailing Address - Country:US
Mailing Address - Phone:706-963-0894
Mailing Address - Fax:
Practice Address - Street 1:625 CHATTAHOOCHEE WINDS DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-3208
Practice Address - Country:US
Practice Address - Phone:706-963-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008377101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty