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General NPI Number Information
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NPI Number | 1083563746
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Entity Type | Individual
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Provider Name | CARMEN NI'ASIA JEFFERSON
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Gender | Female
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 390 S LIBERTY ST
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City | WINSTON SALEM
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State | NC
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Zip | 27101-5260
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Country | US
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Telephone | 336-934-4058
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Fax |
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Provider Business Mailing Address
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Address Line | 102 BLOSSOM CIR
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City | LEXINGTON
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State | NC
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Zip | 27292-4183
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Country | US
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Telephone | 980-312-7608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | NC
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