Provider Demographics
NPI:1770794422
Name:JEFFERY, JASON (LCPC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:JEFFERY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 16TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2809
Mailing Address - Country:US
Mailing Address - Phone:202-291-9186
Mailing Address - Fax:
Practice Address - Street 1:8737 COLESVILLE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3928
Practice Address - Country:US
Practice Address - Phone:240-296-5625
Practice Address - Fax:301-588-8880
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD248Medicaid