Provider Demographics
NPI:1558332429
Name:JEFFERS, CHERYL SUSAN (LPC MED EDS)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:SUSAN
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:LPC MED EDS
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:SUSAN
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:560 DONNA DR SW
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3504
Mailing Address - Country:US
Mailing Address - Phone:770-433-0322
Mailing Address - Fax:770-433-0322
Practice Address - Street 1:1640 POWERS FERRY RD
Practice Address - Street 2:BLDG 8 STE 150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:678-933-7386
Practice Address - Fax:770-433-0322
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 003749101YM0800X, 101YP2500X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy