Individual
KOURTNEY T JEFFERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
8090 WOODLOO DR, ELLICOTT CITY, MD 21043-6921
(336) 327-4714
Mailing address
8090 WOODLOO DR, ELLICOTT CITY, MD 21043-6921
(336) 327-4714
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LC13750
MD
101YM0800X
Mental Health Counselor
Primary
LGP11295
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LGP11295
STATE OF MD
MD
Enumeration date
11/15/2022
Last updated
12/10/2024
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