Healthcare Provider Details

I. General information

NPI: 1902970379
Provider Name (Legal Business Name): VIRGINIA E STAFFORD MFCC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 SILVER AVE SE
ALBUQUERQUE NM
87106-4010
US

IV. Provider business mailing address

203 VASSAR DR SE APT C
ALBUQUERQUE NM
87106-2881
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-2855
  • Fax:
Mailing address:
  • Phone: 505-342-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC04772
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC24668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: