MEDICARE: ARIANNA STAFFORD LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC11534	MD

General Provider Information

NPI Number	:	1164074811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIANNA STAFFORD LCPC

Provider Business Mailing Address
First Line	:	915 S WOLFE ST APT 527
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21231-3646
Country	:	US
Telephone Number	:	216-403-1171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 BREWERS GREEN WAY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5385
Country	:	US
Telephone Number	:	410-216-4324
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	05/25/2026

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