National Provider Identifier Database

CORTNY M STARK, MA, LPCC, LADAC, CRC – NPI #1104176148
Professional


Contact Information

CORTNY M STARK, MA, LPCC, LADAC, CRC
1316 JACKIE RD SE STE 900
RIO RANCHO, NM87124
Phone: 505-289-1042
Fax:
Website:
Specialty Taxonomy Code
* Professional 101YP2500X
Addiction (Substance Use Disorder) 101YA0400X
Rehabilitation 103TR0400X

* Indicates primary specialty

NPI Profile & details for CORTNY M STARK

NPI Number 1104176148
Credentials MA, LPCC, LADAC, CRC
Entity Individual
Enumeration date 09/18/2012
Last updated 08/30/2018 - About 8 years ago
Sole proprietor1 No
Identifiers
  • NM License #: 00165351
  • NM License #: CAD0171001
  • NM License #: CCMH0198781
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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