Individual
EDWARD MANCILE JEFFERSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2800 W WILLOW ST, LANSING, MI 48917-1833
(517) 323-4734
(517) 886-1158
Mailing address
2800 W WILLOW ST, LANSING, MI 48917-1833
(517) 323-4734
(517) 556-1158
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401015665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6401015664
—
MI
Enumeration date
01/11/2018
Last updated
01/11/2018
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