Provider Demographics
NPI:1972138634
Name:STARKE, DESTANEY LASHAY (SERVICE FACILITATOR)
Entity type:Individual
Prefix:
First Name:DESTANEY
Middle Name:LASHAY
Last Name:STARKE
Suffix:
Gender:F
Credentials:SERVICE FACILITATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10448 CENTRALIA STATION RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10448 CENTRALIA STATION RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1143
Practice Address - Country:US
Practice Address - Phone:804-919-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0779268280Medicaid