Provider Demographics
NPI:1124133327
Name:JEFFERSON AND ASSOCIATES PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:JEFFERSON AND ASSOCIATES PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-385-0744
Mailing Address - Street 1:3712 OLD FOREST RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6959
Mailing Address - Country:US
Mailing Address - Phone:434-385-0744
Mailing Address - Fax:434-385-8358
Practice Address - Street 1:3712 OLD FOREST RD
Practice Address - Street 2:SUITE 500
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6959
Practice Address - Country:US
Practice Address - Phone:434-385-0744
Practice Address - Fax:434-385-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
VA0810001866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06393Medicare ID - Type UnspecifiedGROUP- MEDICARE NUMBER