Individual
MRS. CASSONDA ANNE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
1107 S ATKINSON AVE, ROSWELL, NM 88203-7154
(575) 578-4826
Mailing address
1107 S ATKINSON AVE, ROSWELL, NM 88203-7154
(575) 578-4826
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAD0196841
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05
—
NM
Enumeration date
06/11/2019
Last updated
06/11/2019
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