Provider Demographics
NPI:1750667150
Name:JEFFREY, ARLEATHA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ARLEATHA
Middle Name:
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AJ
Other - Middle Name:
Other - Last Name:JEFFREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4016 LAKOTA CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4074
Mailing Address - Country:US
Mailing Address - Phone:843-615-5570
Mailing Address - Fax:
Practice Address - Street 1:8511 DAVIS LAKE PKWY STE C6-274
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0536
Practice Address - Country:US
Practice Address - Phone:843-615-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC007490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750667150OtherNPI