Provider Demographics
NPI:1326578337
Name:STALFORD, JULIE ANN (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:STALFORD
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 OLD HENDERSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3623
Mailing Address - Country:US
Mailing Address - Phone:210-781-0254
Mailing Address - Fax:
Practice Address - Street 1:1170 OLD HENDERSON RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3623
Practice Address - Country:US
Practice Address - Phone:210-781-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700527104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker