Healthcare Provider Details

I. General information

NPI: 1669354155
Provider Name (Legal Business Name): ANGELINA MARIE JEFFERY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 8
CLEVELAND OH
44125-1979
US

IV. Provider business mailing address

13201 GRANGER RD STE 8
CLEVELAND OH
44125-1979
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-2255
  • Fax:
Mailing address:
  • Phone: 216-831-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608599
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: