Individual
MR. MARK JUDE STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1003 HUGH WALLIS RD S, C-6, LAFAYETTE, LA 70508-2528
(337) 344-1617
Mailing address
112 HOWARD AVE, LAFAYETTE, LA 70506-4402
(337) 344-1617
(337) 289-9336
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10658
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10658
LCSW LICENSE #
LA
Enumeration date
04/07/2012
Last updated
04/07/2012
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