Healthcare Provider Details

I. General information

NPI: 1891122982
Provider Name (Legal Business Name): MRS. ANGELA DENISE JEFFERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date: 03/02/2018
Reactivation Date: 09/27/2018

III. Provider practice location address

1200 1ST ST NE
WASHINGTON DC
20002-3361
US

IV. Provider business mailing address

6420 SYMPOSIUM WAY
CLINTON MD
20735-3862
US

V. Phone/Fax

Practice location:
  • Phone: 202-442-4800
  • Fax:
Mailing address:
  • Phone: 301-868-0516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: