Healthcare Provider Details

I. General information

NPI: 1720120785
Provider Name (Legal Business Name): JESSICA ALLYN EFIRD MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 LE PHILLIP CT SUITE 106
CONCORD NC
28025-2984
US

IV. Provider business mailing address

604 PEACH ST
KANNAPOLIS NC
28083-5131
US

V. Phone/Fax

Practice location:
  • Phone: 704-782-3004
  • Fax: 704-782-3005
Mailing address:
  • Phone: 704-502-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: