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Individual
NICOLE JEFFERSON
Active
Individual
NICOLE JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
311ZA0620X
Adult Care Home Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/16/2018
Last updated
08/13/2023
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