Provider Demographics
NPI:1891122982
Name:JEFFERSON, ANGELA DENISE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENISE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 SYMPOSIUM WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3862
Mailing Address - Country:US
Mailing Address - Phone:301-868-0516
Mailing Address - Fax:
Practice Address - Street 1:1200 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3361
Practice Address - Country:US
Practice Address - Phone:202-442-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2018-09-27
Deactivation Date:2018-03-02
Deactivation Code:
Reactivation Date:2018-09-27
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool