Provider Demographics
NPI:1215527726
Name:STANFORD, WINSTON DIONDRE
Entity type:Individual
Prefix:MR
First Name:WINSTON
Middle Name:DIONDRE
Last Name:STANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CRESTWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1410
Mailing Address - Country:US
Mailing Address - Phone:478-538-6178
Mailing Address - Fax:
Practice Address - Street 1:606 E SPRING ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5066
Practice Address - Country:US
Practice Address - Phone:931-303-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool