Provider Demographics
NPI:1225466931
Name:JEFFERSON, NNEKA L (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:NNEKA
Middle Name:L
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 KILMER ST
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1308
Mailing Address - Country:US
Mailing Address - Phone:571-402-2816
Mailing Address - Fax:
Practice Address - Street 1:704 26TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3266
Practice Address - Country:US
Practice Address - Phone:202-724-4657
Practice Address - Fax:202-442-8438
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149011041C0700X
DC1041S0200X
DCLC500786741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool