Individual
MR. CARL DENNIS STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
HIGHWAY 60 22 WEST, BLANDYWAY OFFICE PARK, MILLEDGEVILLE, GA 31061
(478) 445-1290
(478) 445-1296
Mailing address
175 EMERY HWY, MACON, GA 31217-3692
(478) 803-7631
(478) 751-4530
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
406
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
406
LCSW
GA
Enumeration date
09/01/2006
Last updated
08/02/2012
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