MEDICARE: MR. JAMES A 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	101YP2500X	Professional Counselor	LC3470	MD

General Provider Information

NPI Number	:	1942534409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A STAFFORD LCPC

Provider Business Mailing Address
First Line	:	102 OLD SOLOMONS ISLAND RD
Second Line	:	SUITE 202
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3816
Country	:	US
Telephone Number	:	410-266-3058
Fax Number	:	410-266-3257

Provider Business Practice Location Address
First Line	:	102 OLD SOLOMONS ISLAND RD
Second Line	:	SUITE 202
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3816
Country	:	US
Telephone Number	:	410-266-3058
Fax Number	:	410-266-3257

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

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	12/02/2016

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