Kimberly J Stafford, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401010739 Issued in MI

Practice address

243 Lakewood St
Detroit, MI 48215-3151

Phone

(313) 420-9537

NPI assigned

Apr 23, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: kimberly.stafford.1@19800.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Covenant Community Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1720134943
  Medicare reassignment
• Quest Counseling Services

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1780046128
  NPD (past) Authorized official
• Covenant Community Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1689925075
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433894400000",
    "number": "1306011283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922468",
            "telephone_number": "586-753-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 LAKEWOOD ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482153151",
            "telephone_number": "313-420-9537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2015-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401010739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas David Stackpoole, PT
• Herman Stacy
• Joshua Michael Stadler, RN
• Diane Stafford
• Kerri M Stafford, CRNA
• Serah Stafford
• Lisa D. Stagner, D.O.
• Alexandra D Staley, MA, TLLP
• Jeffery Harrison Stallings, L.L.P.
• Stallworth Afc #1 Corporation

• Professional Counselor in Detroit, MI
• Providers in Detroit, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.