Cowenda Shavonne Jefferson, MA LPC NCC CCAADC
Counselor, Professional in Hogansville, GA. Individual provider (NPI-1).
NPI number1003911348
StatusActive
Last updated in NPPESMay 20, 2019
Details
- NPI
- 1003911348
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Cowenda Shavonne Jefferson
- Credential
- MA LPC NCC CCAADC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 13, 2006
- Last updated
- May 20, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | LPC006320 | GA | Yes |
| 101Y00000X | Counselor | 229340 | GA | |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | C0101 | GA |
Practice location
103 Renae LnHogansville, GA 30230
Phone 762-323-9693
Mailing address
103 Renae LnHogansville, GA 30230-3434
Phone 762-323-9693
Other practice locations
120 Gordon Commercial Dr Ste B
Lagrange, GA 30240-5753
Lagrange, GA 30240-5753
Phone 706-845-4054 · Fax 706-845-4430
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