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NPI Code Detail

MEDICARE: JERMECKIA SANDEFER MS

MEDICARE: JERMECKIA SANDEFER MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health Counselor
3101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1144908617
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERMECKIA SANDEFER MS
Provider Business Mailing Address
First Line : 223 DUNBAR CAVE SUITE A
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37044-1133
Country : US
Telephone Number : 615-657-4025
Fax Number :
Provider Business Practice Location Address
First Line : 223 DUNBAR CAVE RD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-8830
Country : US
Telephone Number : 931-209-1673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2023
Last Update Date : 07/06/2023

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Directions to “ JERMECKIA SANDEFER MS” Practice Location

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