Provider Demographics
NPI:1346956604
Name:JEFFERSON, DEVON MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:MICHELLE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 ROGERS RD UNIT 9208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3680
Mailing Address - Country:US
Mailing Address - Phone:210-723-3627
Mailing Address - Fax:
Practice Address - Street 1:2210 ROGERS RD UNIT 9208
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3680
Practice Address - Country:US
Practice Address - Phone:210-723-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical