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General NPI Number Information
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NPI Number | 1124133327
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Entity Type | Organization
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Legal Business Name | JEFFERSON AND ASSOCIATES PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 3712 OLD FOREST RD SUITE 500
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City | LYNCHBURG
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State | VA
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Zip | 24501-6959
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Country | US
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Telephone | 434-385-0744
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Fax | 434-385-8358
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Provider Business Mailing Address
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Address Line | 3712 OLD FOREST RD SUITE 500
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City | LYNCHBURG
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State | VA
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Zip | 24501-6959
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Country | US
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Telephone | 434-385-0744
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Fax | 434-385-8358
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TERRY W. JEFFERSON
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Credential | PH.D.
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Telephone | 434-385-0744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001866
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License Number State | VA
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