Provider Demographics
NPI:1194050872
Name:STAFFORD, VANESSA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38086 LANTERN HILL CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2896
Mailing Address - Country:US
Mailing Address - Phone:248-848-7088
Mailing Address - Fax:248-848-9763
Practice Address - Street 1:32231 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4312
Practice Address - Country:US
Practice Address - Phone:734-266-6800
Practice Address - Fax:734-266-6015
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010194881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical