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Individual

LAQUANDA JEFFERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
870 CRESTMARK DR STE 103, LITHIA SPRINGS, GA 30122-2665
(770) 672-0376
(770) 672-0376
Mailing address
PO BOX 5191, DOUGLASVILLE, GA 30154-0004

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
106H00000X
Marriage & Family Therapist
106S00000X
Behavior Technician
171M00000X
Case Manager/Care Coordinator
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
07/31/2017
Last updated
07/31/2017
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