Healthcare Provider Details

I. General information

NPI: 1063964625
Provider Name (Legal Business Name): SARAH R STAFFORD PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

IV. Provider business mailing address

8479 S. MASON MONTGOMERY ROAD SUITE 4
MASON OH
45040-4023
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5722
  • Fax: 614-889-9335
Mailing address:
  • Phone: 513-445-8560
  • Fax: 513-725-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC 1500156
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1800965
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: