| Pamela K Stafford Sole Mbr | |
|
6334 Saint Andrews Rd Suite 204 Columbia SC 29212-3143 | |
| (803) 764-0961 | |
| (803) 764-0961 |
| Full Name | Pamela K Stafford Sole Mbr |
|---|---|
| Speciality | Counselor - Professional |
| Location | 6334 Saint Andrews Rd, Columbia, South Carolina |
| Authorized Official Name and Position | Pam Stafford (OWNER) |
| Authorized Official Contact | 8037640961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pamela K Stafford Sole Mbr 6334 Saint Andrews Rd Suite 204 Columbia SC 29212-3143 Ph: (803) 764-0961 | Pamela K Stafford Sole Mbr 6334 Saint Andrews Rd Suite 204 Columbia SC 29212-3143 Ph: (803) 764-0961 |
| NPI Number | 1336518448 |
|---|---|
| Provider Enumeration Date | 09/18/2015 |
| Last Update Date | 09/18/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336518448 | NPI | - | NPPES |
| PC1305 | Medicaid | SC | |
| 12370180 | Other | SC | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC 5564 (South Carolina) | Primary |
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