Provider Demographics
NPI:1427430404
Name:STAFFORD, ANNA (MA ED,S LPC, NCC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MA ED,S LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CORNER OAK CT
Mailing Address - Street 2:#1098
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-4210
Mailing Address - Country:US
Mailing Address - Phone:678-516-7921
Mailing Address - Fax:
Practice Address - Street 1:153 CORNER OAK CT
Practice Address - Street 2:#1098
Practice Address - City:WALESKA
Practice Address - State:GA
Practice Address - Zip Code:30183-4210
Practice Address - Country:US
Practice Address - Phone:678-516-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional