Provider Demographics
NPI:1306070610
Name:JEFFERSON, LINDA ANN (CRC, CDMS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:CRC, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 8787
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202
Mailing Address - Country:US
Mailing Address - Phone:843-537-4440
Mailing Address - Fax:
Practice Address - Street 1:136 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-8447
Practice Address - Country:US
Practice Address - Phone:843-921-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor