Doctor Name: | LISA P STAFFORD |
NPI Number: | 1013188101 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS,CSP |
License Number: | 11106 |
Business Practice Address: | 104 Sistersville Pike West Union, WV - 264561034 |
Business Phone Number: | 3046246554 |
Business Fax Number: | 3046245223 |
Mailing Address: | 104 Sistersville Pike, WEST UNION |
State: | WV |
Postal Code: | 264561034 |
Phone Number: | 3046246554 |
Fax Number: | 3046245223 |
NPI Enumeration Date: | 03/17/2008 |
NPI Last Update Date: | 03/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 11106 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |