Provider Demographics
NPI:1871453530
Name:STAFFORD, CAROLINE LOUISE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LOUISE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E MAIN STE 103
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6768
Mailing Address - Country:US
Mailing Address - Phone:253-271-4267
Mailing Address - Fax:
Practice Address - Street 1:1011 E MAIN STE 103
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6768
Practice Address - Country:US
Practice Address - Phone:253-271-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC.70015308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health