Provider Demographics
NPI:1205299567
Name:STAFFORD, KHALILAH SALAAM
Entity type:Individual
Prefix:MRS
First Name:KHALILAH
Middle Name:SALAAM
Last Name:STAFFORD
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 1:1613 BRAMWELL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-7803
Mailing Address - Country:US
Mailing Address - Phone:804-939-0500
Mailing Address - Fax:804-674-4731
Practice Address - Street 1:1613 BRAMWELL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-7803
Practice Address - Country:US
Practice Address - Phone:804-939-0500
Practice Address - Fax:804-674-4731
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker