Individual
MS. CORTNY M STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC, LADAC, CRC
Contact information
Practice address
1316 JACKIE RD SE STE 900, RIO RANCHO, NM 87124
(505) 289-1042
Mailing address
2605 INCA RD NE, RIO RANCHO, NM 87144-7558
(505) 452-7635
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAD0171001
NM
101YP2500X
Professional Counselor
Primary
CCMH0198781
NM
103TR0400X
Rehabilitation Psychologist
00165351
NM
Other
Enumeration date
09/18/2012
Last updated
08/30/2018
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