Provider Demographics
NPI:1871860973
Name:JEFFERS, KENDRA D (LCPC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:D
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON GROVE
Mailing Address - State:MD
Mailing Address - Zip Code:20880-1066
Mailing Address - Country:US
Mailing Address - Phone:301-237-5346
Mailing Address - Fax:
Practice Address - Street 1:5880 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4821
Practice Address - Country:US
Practice Address - Phone:301-237-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD45-3729156Medicaid