Provider Demographics
NPI:1477911014
Name:STAFFORD, DANITA (PROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 SOOTHING MEADOWS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-4106
Mailing Address - Country:US
Mailing Address - Phone:505-358-2838
Mailing Address - Fax:
Practice Address - Street 1:2337 PICKWICK DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3753
Practice Address - Country:US
Practice Address - Phone:702-359-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2022-03-28
Deactivation Date:2020-10-31
Deactivation Code:
Reactivation Date:2022-03-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health