Individual
MRS. KELLY LOGAN STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
357 TOWNE CENTER PL, SUITE 402, RIDGELAND, MS 39157-4870
(601) 573-7908
(601) 510-9356
Mailing address
PO BOX 2582, MADISON, MS 39130-2582
(601) 573-7908
(601) 510-9356
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1320
MS
Other
Enumeration date
01/09/2012
Last updated
01/09/2012
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