Provider Demographics
NPI:1750823803
Name:STANFORD, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W QUEENS WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4085
Mailing Address - Country:US
Mailing Address - Phone:757-864-0675
Mailing Address - Fax:757-282-7744
Practice Address - Street 1:10 W QUEENS WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4085
Practice Address - Country:US
Practice Address - Phone:757-864-0675
Practice Address - Fax:757-282-7744
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040096471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical