Provider Demographics
NPI:1447579925
Name:JEFFERSON PSYCHOLOGICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:JEFFERSON PSYCHOLOGICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:678-741-5310
Mailing Address - Street 1:3400 CHAPEL HILL RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1739
Mailing Address - Country:US
Mailing Address - Phone:678-741-5310
Mailing Address - Fax:678-298-9899
Practice Address - Street 1:3400 CHAPEL HILL RD
Practice Address - Street 2:SUITE 212
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1739
Practice Address - Country:US
Practice Address - Phone:678-741-5310
Practice Address - Fax:678-298-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003323251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health