Provider Demographics
NPI:1609800382
Name:JEFFERY, KATHRYN (MED LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ORANGEBURG AREA MENTAL HEALTH CENTER
Mailing Address - Street 2:2319 ST. MATTHEWS ROAD
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-536-1571
Mailing Address - Fax:803-534-1693
Practice Address - Street 1:ORANGEBURG AREA MENTAL HEALTH CENTER
Practice Address - Street 2:2319 ST. MATTHEWS ROAD
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-536-1571
Practice Address - Fax:803-534-1693
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional