Provider Demographics
NPI:1720451628
Name:STAFFORD, NANCI (LCSW)
Entity type:Individual
Prefix:DR
First Name:NANCI
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCI
Other - Middle Name:
Other - Last Name:BURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:121 ROLLING HILL RD STE 225
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8861
Mailing Address - Country:US
Mailing Address - Phone:704-534-5997
Mailing Address - Fax:
Practice Address - Street 1:121 ROLLING HILL RD STE 225
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8861
Practice Address - Country:US
Practice Address - Phone:704-534-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14762104100000X, 1041C0700X
NCC0029301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty