Provider Demographics
NPI:1083993414
Name:JEFFERSON, BRITTANY SANTANA (LAC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SANTANA
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5364
Mailing Address - Country:US
Mailing Address - Phone:870-604-4455
Mailing Address - Fax:888-977-2956
Practice Address - Street 1:1707 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5364
Practice Address - Country:US
Practice Address - Phone:870-604-4455
Practice Address - Fax:888-977-2956
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2201018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health