Provider Demographics
NPI:1578218525
Name:JEFFERS, RAYLEE NICOLE (BSW, CAADC DP-C)
Entity Type:Individual
Prefix:
First Name:RAYLEE
Middle Name:NICOLE
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:BSW, CAADC DP-C
Other - Prefix:
Other - First Name:RAYLEE
Other - Middle Name:NICOLE
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, CAADC DP-C
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MI
Mailing Address - Zip Code:48731-0278
Mailing Address - Country:US
Mailing Address - Phone:989-975-9525
Mailing Address - Fax:
Practice Address - Street 1:5203 WHALEN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MI
Practice Address - Zip Code:48731-5162
Practice Address - Country:US
Practice Address - Phone:989-975-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty