Provider Demographics
NPI:1306197264
Name:JEFFERS-ATKINS, BRYAN DAVID (BA, CDP, AAC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DAVID
Last Name:JEFFERS-ATKINS
Suffix:
Gender:M
Credentials:BA, CDP, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 N 37TH ST
Mailing Address - Street 2:LL-12
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2666
Mailing Address - Country:US
Mailing Address - Phone:253-302-5668
Mailing Address - Fax:253-301-1776
Practice Address - Street 1:5601 N 37TH ST
Practice Address - Street 2:LL-12
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2666
Practice Address - Country:US
Practice Address - Phone:253-302-5668
Practice Address - Fax:253-301-1776
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006148101YA0400X
WACG60277350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)