Provider Demographics
NPI:1982997334
Name:STRADFORD, MONICA ELAINE (MA)
Entity type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:ELAINE
Last Name:STRADFORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4144
Mailing Address - Country:US
Mailing Address - Phone:803-774-2041
Mailing Address - Fax:803-774-2042
Practice Address - Street 1:244 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4144
Practice Address - Country:US
Practice Address - Phone:803-774-2041
Practice Address - Fax:803-774-2042
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional