| Doctor Name: | LEROY STANFORD |
| NPI Number: | 1013395052 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 37LC00215600 |
| Business Practice Address: | 2600 Mount Ephraim Ave Suite 405 Camden, NJ - 081043236 |
| Business Phone Number: | 8569637323 |
| Business Fax Number: | 8569637324 |
| Mailing Address: | 2600 Mount Ephraim Ave, Suite 405 CAMDEN |
| State: | NJ |
| Postal Code: | 081043236 |
| Phone Number: | 8569637323 |
| Fax Number: | 8569637324 |
| NPI Enumeration Date: | 05/11/2015 |
| NPI Last Update Date: | 05/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00215600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |