Individual
MS. HAVELIAH STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2115 18TH ST, CHARLESTON, IL 61920-4338
(217) 345-4065
Mailing address
1606 11TH ST, CHARLESTON, IL 61920-3509
(815) 503-0452
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.012934
IL
225700000X
Massage Therapist
7501003525
MI
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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