Provider Demographics
NPI:1164074811
Name:STAFFORD, ARIANNA (LGPC)
Entity Type:Individual
Prefix:
First Name:ARIANNA
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S WOLFE ST APT 527
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3646
Mailing Address - Country:US
Mailing Address - Phone:216-403-1171
Mailing Address - Fax:
Practice Address - Street 1:20 CROSSROADS DR STE 105
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5480
Practice Address - Country:US
Practice Address - Phone:410-356-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health