Provider Demographics
NPI:1891704920
Name:JUSTICE, JEFFERY CHARLES (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:CHARLES
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 HONEYSUCKLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305
Mailing Address - Country:US
Mailing Address - Phone:334-794-2113
Mailing Address - Fax:334-702-1220
Practice Address - Street 1:1841 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4269
Practice Address - Country:US
Practice Address - Phone:334-794-2113
Practice Address - Fax:334-702-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional