Provider Demographics
NPI:1518602374
Name:STAFFORD, JOSHUA JOSEPH (LCADC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOSEPH
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-9718
Mailing Address - Country:US
Mailing Address - Phone:609-892-7564
Mailing Address - Fax:
Practice Address - Street 1:704 N 4TH ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9718
Practice Address - Country:US
Practice Address - Phone:609-892-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37L00364900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)