Organization
STANFORD CTC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEROY STANFORD JR. LCADC (CEO)
(856) 302-6437
Entity
Organization
Contact information
Practice address
141 S BLACK HORSE PIKE STE 204, BLACKWOOD, NJ 08012-2975
(856) 302-6437
(856) 302-5532
Mailing address
24 PATRICIA LN, SICKLERVILLE, NJ 08081-1810
(856) 728-6029
(856) 302-5532
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/31/2018
Last updated
09/18/2020
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