Provider Demographics
NPI:1275116436
Name:JIFUNZA, DEMETRIUS (LMHC)
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:JIFUNZA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT. #394
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:34148
Mailing Address - Country:US
Mailing Address - Phone:941-300-4440
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:14243 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2215
Practice Address - Country:US
Practice Address - Phone:941-888-2144
Practice Address - Fax:888-213-0604
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health