Provider Demographics
NPI:1982935961
Name:JEFFERSON, DAMITA JOVAN (MSW)
Entity Type:Individual
Prefix:
First Name:DAMITA
Middle Name:JOVAN
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 BRANDENBURG BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9259
Mailing Address - Country:US
Mailing Address - Phone:317-658-0043
Mailing Address - Fax:317-845-8476
Practice Address - Street 1:5170 E 65TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4892
Practice Address - Country:US
Practice Address - Phone:317-845-8475
Practice Address - Fax:317-845-8476
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker