Provider Demographics
NPI:1841854445
Name:JEFFERSON, DERSHAWN (LCSW)
Entity type:Individual
Prefix:
First Name:DERSHAWN
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2239
Mailing Address - Country:US
Mailing Address - Phone:804-643-6761
Mailing Address - Fax:804-643-0734
Practice Address - Street 1:6 N 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2239
Practice Address - Country:US
Practice Address - Phone:804-643-6761
Practice Address - Fax:804-643-0734
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040107941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical