Individual
MS. MARSHA KAY STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDC, LPP
Contact information
Practice address
76 E 7570 S, MIDVALE, UT 84047-2633
(801) 574-8765
Mailing address
76 E 7570 S, MIDVALE, UT 84047-2633
(801) 574-8765
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6300986-6006
UT
174400000X
Specialist
6300986-5001
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13309154
DRIVERS LICENSE
UT
Enumeration date
08/03/2016
Last updated
08/03/2016
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