Provider Demographics
NPI:1295059970
Name:JEFFERSON, KATRINA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MSW, LCSW
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 307
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-0307
Mailing Address - Country:US
Mailing Address - Phone:304-634-0274
Mailing Address - Fax:304-736-6677
Practice Address - Street 1:5930 MAHOOD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2210
Practice Address - Country:US
Practice Address - Phone:304-634-0274
Practice Address - Fax:304-736-6677
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00940811101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist