Healthcare Provider Details

I. General information

NPI: 1144158734
Provider Name (Legal Business Name): RAYMOND JEFFERIES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MERCANTILE LN STE 521
LARGO MD
20774-4321
US

IV. Provider business mailing address

7905 CANDLEWOOD PL
GREENBELT MD
20770-3027
US

V. Phone/Fax

Practice location:
  • Phone: 301-485-9387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP17887
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: