Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003265224 |
---|---|
Provider Name | P'anna Jefferies |
First Address | Sacramento, CA 95826-2401 |
Second Address | Diamond Springs, CA 95619-9781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 08/06/2016 |