Provider Demographics
NPI:1790990430
Name:STAFFORD, JAMES DOUGLAS (ACSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41647 HIGHWAY 315
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-8353
Mailing Address - Country:US
Mailing Address - Phone:662-609-1836
Mailing Address - Fax:662-915-6917
Practice Address - Street 1:41647 HIGHWAY 315
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8353
Practice Address - Country:US
Practice Address - Phone:662-609-1836
Practice Address - Fax:662-915-6917
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC07801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC0780OtherSTATE SOCIAL WORK LICENSE