Provider Demographics
NPI:1689766644
Name:JEFFRIES, CANDACE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MAKENZIE LN
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-9487
Mailing Address - Country:US
Mailing Address - Phone:606-878-2141
Mailing Address - Fax:
Practice Address - Street 1:1675 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2050
Practice Address - Country:US
Practice Address - Phone:606-878-1961
Practice Address - Fax:606-877-1958
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical