Provider Demographics
NPI:1679228753
Name:STARR, SALLY (LPC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35273 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-3106
Mailing Address - Country:US
Mailing Address - Phone:571-383-8054
Mailing Address - Fax:
Practice Address - Street 1:1 PARK CENTER CT
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-5270
Practice Address - Country:US
Practice Address - Phone:571-383-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health