Jeremy M Stark, LCSW
Social Worker, Clinical in Fayetteville, AR. Individual provider (NPI-1).
NPI number1154772689
StatusActive
Last updated in NPPESDec 14, 2018
Details
- NPI
- 1154772689
- Entity type
- Individual (NPI-1)
- Name
- Jeremy M Stark
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 27, 2016
- Last updated
- Dec 14, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 8044-C | AR | Yes |
| 104100000X | Social Worker | 8044-M | AR |
Practice location
60 W Sunbridge DrFayetteville, AR 72703-1822
Phone 479-695-1240 · Fax 479-750-4843
Mailing address
2400 S 48th StSpringdale, AR 72762-6683
Phone 479-750-2020 · Fax 479-750-4843
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