Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 229340 | GA |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | C0101 | GA |
Y | 101YP2500X | Professional Counselor | LPC006320 | GA |
NPI | 1003911348 |
---|---|
Provider Name | Mrs. Cowenda Shavonne Jefferson |
First Address | Hogansville, GA 30230-3434 |
Second Address | Hogansville, GA 30230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 20/05/2019 |