Provider Demographics
NPI:1295586410
Name:JEFFERSON, TAKIRA SHARAE
Entity type:Individual
Prefix:
First Name:TAKIRA
Middle Name:SHARAE
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 1:1168 BEIDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-4234
Mailing Address - Country:US
Mailing Address - Phone:856-408-4192
Mailing Address - Fax:
Practice Address - Street 1:7100 AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4302
Practice Address - Country:US
Practice Address - Phone:609-707-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor