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General NPI Number Information
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NPI Number | 1104619329
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Entity Type | Organization
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Legal Business Name | STAFFORD SERVICES OF COASTAL GEORGIA LLC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 185 RICHARD DAVIS DR STE 105
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3978
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Country | US
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Telephone | 833-779-3825
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1943
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City | RICHMOND HILL
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State | GA
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Zip | 31324-1943
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LEAD PSYCHOLOGIST
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Name | DR. CANDACE M. STAFFORD
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Credential | PSY.D.
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Telephone | 833-779-3825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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