Provider Demographics
NPI:1821537614
Name:STAFFORD COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:STAFFORD COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROLLINS
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-594-0011
Mailing Address - Street 1:PO BOX 2582
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-2582
Mailing Address - Country:US
Mailing Address - Phone:601-594-0011
Mailing Address - Fax:
Practice Address - Street 1:357 TOWNE CENTER PL
Practice Address - Street 2:SUITE 402
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4870
Practice Address - Country:US
Practice Address - Phone:601-594-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS959101YP2500X
MS1320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1598938847OtherNPI
MS08600503Medicaid
MS1578833521OtherNPI