Provider Demographics
NPI:1467790261
Name:JEFFERY-JOHNSON, GENEAN (MA)
Entity type:Individual
Prefix:
First Name:GENEAN
Middle Name:
Last Name:JEFFERY-JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ADDISON ST STE 331
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1192
Mailing Address - Country:US
Mailing Address - Phone:510-655-1681
Mailing Address - Fax:
Practice Address - Street 1:2001 ADDISON ST STE 331
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1192
Practice Address - Country:US
Practice Address - Phone:510-919-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health