Provider Demographics
NPI:1003570060
Name:JEFFERSON, SIERRA (LMSW)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 BERGIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7049
Mailing Address - Country:US
Mailing Address - Phone:810-444-2484
Mailing Address - Fax:
Practice Address - Street 1:10075 BERGIN RD STE C
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7049
Practice Address - Country:US
Practice Address - Phone:810-444-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851110406104100000X
MI68011175351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker