Provider Demographics
NPI:1912362534
Name:STAFFORD, ANTHONY CRAIGH
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CRAIGH
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 GUS KAPLAN DR STE C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3377
Mailing Address - Country:US
Mailing Address - Phone:318-704-6591
Mailing Address - Fax:888-662-1332
Practice Address - Street 1:2006 GUS KAPLAN DR STE C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3377
Practice Address - Country:US
Practice Address - Phone:318-704-6591
Practice Address - Fax:888-662-1332
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-25
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health