Provider Demographics
NPI:1134838576
Name:JEFFERS, KOURTNEY T (LCPC)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:T
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 1:8090 WOODLOO DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6921
Mailing Address - Country:US
Mailing Address - Phone:336-327-4714
Mailing Address - Fax:
Practice Address - Street 1:8090 WOODLOO DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6921
Practice Address - Country:US
Practice Address - Phone:336-327-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13750101YM0800X
MDLGP11295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP11295OtherSTATE OF MD