Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1326518135 |
---|---|
Provider Name | Jamese Jefferson |
First Address | Waldorf, MD 20603-6706 |
Second Address | Waldorf, MD 20603-6706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2018 |
Last Update Date | 05/12/2018 |