Provider Demographics
NPI:1912457623
Name:STAFFORD, ROSHEL CATIA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ROSHEL
Middle Name:CATIA
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ROSHEL
Other - Middle Name:CATIA
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLBSW
Mailing Address - Street 1:3124 N WELLNESS DR STE 60
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8121
Mailing Address - Country:US
Mailing Address - Phone:616-805-3660
Mailing Address - Fax:
Practice Address - Street 1:3124 N WELLNESS DR STE 60
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8121
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:616-805-3631
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011087591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical