Provider Demographics
NPI:1063964625
Name:STAFFORD, SARAH R (PCC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:R
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8479 S. MASON MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-4023
Mailing Address - Country:US
Mailing Address - Phone:513-445-8560
Mailing Address - Fax:513-725-1141
Practice Address - Street 1:299 CRAMER CREEK CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2586
Practice Address - Country:US
Practice Address - Phone:614-889-5722
Practice Address - Fax:614-889-9335
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1500156101YP2500X
OHE.1800965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259713Medicaid