Provider Demographics
NPI:1780880286
Name:JEFFERS, VIRGINIA WILSON (LCSW LCAS)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:WILSON
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:LCSW LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 CABARRUS AVE E STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3781
Mailing Address - Country:US
Mailing Address - Phone:888-849-7379
Mailing Address - Fax:855-857-7333
Practice Address - Street 1:725 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4206
Practice Address - Country:US
Practice Address - Phone:336-607-8523
Practice Address - Fax:336-733-0913
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1337101YA0400X
NCC0042431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1434VOtherBCBSNC
NC6003636Medicaid
NC11915020OtherCAQH
NC2851512BMedicare UPIN