Provider Demographics
NPI:1225466931
Name:JEFFERSON, NNEKA L (LICSW, LCSW-C, LCSW)
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:L
Last Name:JEFFERSON
Suffix:
Gender:
Credentials:LICSW, LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 BALTIMORE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1054
Mailing Address - Country:US
Mailing Address - Phone:571-402-2816
Mailing Address - Fax:
Practice Address - Street 1:6200 BALTIMORE AVE STE 300
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1054
Practice Address - Country:US
Practice Address - Phone:571-402-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070921041C0700X
DCLC500786741041C0700X
MD149011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical