Organization
SELF-DETERMINATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLOYDCE JEFFERIES (PRESIDENT)
(828) 433-0465
Entity
Organization
Contact information
Practice address
103 EBENEZER RD, KINGS MTN, NC 28086
(704) 750-4752
(704) 750-4753
Mailing address
103 EBENEZER RD, KINGS MTN, NC 28086-8762
(704) 750-4752
(704) 750-4753
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
023-197
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
012-129
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604454
—
NC
Enumeration date
12/09/2009
Last updated
08/10/2018
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