Provider Demographics
NPI:1760089825
Name:JEFFREYS, CHRISTINE LYNN (LCMHA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:JEFFREYS
Suffix:
Gender:F
Credentials:LCMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 HAMILTON MILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-9007
Mailing Address - Country:US
Mailing Address - Phone:919-628-9887
Mailing Address - Fax:
Practice Address - Street 1:3532 HAMILTON MILL DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-9007
Practice Address - Country:US
Practice Address - Phone:919-628-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15032101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor