Provider Demographics
NPI:1285190439
Name:JEFFERY, STEVEN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHRISTOPHER
Last Name:JEFFERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 HIGHLAND PARC PL SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-2431
Mailing Address - Country:US
Mailing Address - Phone:706-580-0013
Mailing Address - Fax:
Practice Address - Street 1:2232 HIGHLAND PARC PL SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-2431
Practice Address - Country:US
Practice Address - Phone:706-580-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician