# SELF DETERMINATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972954113
- **Authorized official:** MRS. ANNE JEFFRIES BC-HSP (OWNER)
- **Authorized official phone:** (980) 297-8964

## Contact information

- **Practice address:** 423 MILLSAP RD, SHELBY, NC 28150
- **Practice address phone:** (704) 600-6092
- **Mailing address:** 423 MILLSAP RD, SHELBY, NC 28150-9634
- **Mailing address phone:** (704) 600-6092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | 623-203 | NC | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NC | Yes |

## Other

- **Enumeration date:** 06/29/2016
- **Last updated:** 12/08/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | H2020 | — | NC |