Provider Demographics
NPI:1811177488
Name:JEFFERSON, SHERYL DENISE (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:DENISE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 COLUMBIA 100 PKWY
Mailing Address - Street 2:203
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2374
Mailing Address - Country:US
Mailing Address - Phone:443-546-4476
Mailing Address - Fax:443-546-4473
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:203
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2374
Practice Address - Country:US
Practice Address - Phone:443-546-4476
Practice Address - Fax:443-546-4473
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407958200Medicaid
MDH285M199Medicare PIN