Provider Demographics
NPI:1124669072
Name:JEFFERSON, LANITA (LPC)
Entity type:Individual
Prefix:DR
First Name:LANITA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 BELLEVIEW ST STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1871
Mailing Address - Country:US
Mailing Address - Phone:803-315-0302
Mailing Address - Fax:
Practice Address - Street 1:1103 BELLEVIEW ST STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1871
Practice Address - Country:US
Practice Address - Phone:803-315-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health