Provider Demographics
NPI:1548209885
Name:MCCOMBS, JEFFERSON (LPC, MED)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:
Last Name:MCCOMBS
Suffix:
Gender:M
Credentials:LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8381
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-1804
Mailing Address - Country:US
Mailing Address - Phone:704-933-0007
Mailing Address - Fax:704-933-0300
Practice Address - Street 1:608 MCCOMBS AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3605
Practice Address - Country:US
Practice Address - Phone:704-933-0007
Practice Address - Fax:704-933-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1080101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56448OtherBCBS PROVIDER ID