Individual
JANE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
33 VARDEN DR, AIKEN, SC 29803-5285
(803) 642-3801
Mailing address
33 VARDEN DR, AIKEN, SC 29803-5285
(803) 642-3801
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1008
SC
Other
Enumeration date
11/18/2011
Last updated
11/18/2011
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