Healthcare Provider Details

I. General information

NPI: 1861978827
Provider Name (Legal Business Name): TANICA RENEE JEFFRIES LPC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S CENTRAL AVE
COLUMBUS OH
43223-1301
US

IV. Provider business mailing address

2969 GRAND HAVEN DR
PICKERINGTON OH
43147-8713
US

V. Phone/Fax

Practice location:
  • Phone: 614-276-2273
  • Fax:
Mailing address:
  • Phone: 614-395-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: