Provider Demographics
NPI:1912018284
Name:JEFFRIES, DIANE G (LPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:G
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CARTHAGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9438
Mailing Address - Country:US
Mailing Address - Phone:731-989-3401
Mailing Address - Fax:731-989-3838
Practice Address - Street 1:925 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1709
Practice Address - Country:US
Practice Address - Phone:731-989-3401
Practice Address - Fax:731-989-3838
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 328104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3156416OtherBCBS PROVIDER NUMBER