Provider Demographics
NPI:1144422445
Name:SMITH-JEFFERSON, STEPHANIE CECILE (MS, MAMFT-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CECILE
Last Name:SMITH-JEFFERSON
Suffix:
Gender:F
Credentials:MS, MAMFT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 LADNER LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9537
Mailing Address - Country:US
Mailing Address - Phone:601-940-6930
Mailing Address - Fax:601-420-9252
Practice Address - Street 1:5611 HIGHWAY 80 E
Practice Address - Street 2:CROSSROADS COUNSELING CENTER
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8929
Practice Address - Country:US
Practice Address - Phone:601-939-6634
Practice Address - Fax:601-420-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor