Provider Demographics
NPI:1306327358
Name:STAFFORD, ANANCIA S (LCPC)
Entity type:Individual
Prefix:DR
First Name:ANANCIA
Middle Name:S
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-5894
Mailing Address - Country:US
Mailing Address - Phone:773-800-9751
Mailing Address - Fax:
Practice Address - Street 1:73 W MONROE ST STE 228
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-4955
Practice Address - Country:US
Practice Address - Phone:773-413-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012358101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor