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Individual

MR. JAMES VAN JEFFERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LISW

Contact information

Practice address
5110 FAIRFIELD RD, COLUMBIA, SC 29203-4323
(803) 893-7019
Mailing address
PO BOX 740013, ATLANTA, GA 30374-0013
(312) 733-9730
(773) 866-8014

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
15512
SC
104100000X
Social Worker
1041C0700X
Clinical Social Worker
Primary
15512
SC

Other

Enumeration date
09/30/2020
Last updated
07/18/2023
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