Healthcare Provider Details

I. General information

NPI: 1124133327
Provider Name (Legal Business Name): JEFFERSON AND ASSOCIATES PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 OLD FOREST RD SUITE 500
LYNCHBURG VA
24501-6959
US

IV. Provider business mailing address

3712 OLD FOREST RD SUITE 500
LYNCHBURG VA
24501-6959
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-0744
  • Fax: 434-385-8358
Mailing address:
  • Phone: 434-385-0744
  • Fax: 434-385-8358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001866
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. TERRY W. JEFFERSON
Title or Position: OWNER/PRESIDENT
Credential: PH.D.
Phone: 434-385-0744