Provider Demographics
NPI:1437561297
Name:JEFFERSON, AKEEYIA
Entity Type:Individual
Prefix:
First Name:AKEEYIA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 CEDAR VILLAGE TRL
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7294
Mailing Address - Country:US
Mailing Address - Phone:704-449-2907
Mailing Address - Fax:704-909-0234
Practice Address - Street 1:1016 CEDAR VILLAGE TRL
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-7294
Practice Address - Country:US
Practice Address - Phone:704-449-2907
Practice Address - Fax:704-909-0234
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty