Provider Demographics
NPI:1902970379
Name:STAFFORD, VIRGINIA E (MFCC, LPCC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MFCC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 VASSAR DR SE APT C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2881
Mailing Address - Country:US
Mailing Address - Phone:505-342-2855
Mailing Address - Fax:
Practice Address - Street 1:2128 SILVER AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4010
Practice Address - Country:US
Practice Address - Phone:505-342-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC04772101YP2500X
CAMFC24668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist