Provider Demographics
NPI:1326506643
Name:STAFFORD, AMBER LEA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEA
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4313
Mailing Address - Country:US
Mailing Address - Phone:828-467-4728
Mailing Address - Fax:
Practice Address - Street 1:486 SPAULDING RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5212
Practice Address - Country:US
Practice Address - Phone:828-652-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0127521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical