Provider Demographics
NPI:1700080322
Name:STAFFORD, SYBIL ANDRIETTE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SYBIL
Middle Name:ANDRIETTE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 W MARCH LN STE 6
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6415
Mailing Address - Country:US
Mailing Address - Phone:209-954-1311
Mailing Address - Fax:209-951-7083
Practice Address - Street 1:1833 W MARCH LN STE 6
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6415
Practice Address - Country:US
Practice Address - Phone:209-954-1311
Practice Address - Fax:209-951-7083
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist