Basic Information
| Provider Information | |||||||||
| NPI: | 1487690277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STARNES | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | LCSW.LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 84325 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022843425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107153371 | ||||||||
| FaxNumber: | 9107151243 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107153371 | ||||||||
| FaxNumber: | 9107152435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C003885 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6003275 | 05 | NC | MEDICAID |