MEDICARE: MS. CHERYL SUSAN JEFFERS LPC MED EDS

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
1	101YM0800X	Mental Health Counselor	LPC 003749	GA
2	101YP2500X	Professional Counselor	LPC 003749	GA
3	103TP2701X	Group Psychotherapy Psychologist	LPC 003749	GA

General Provider Information

NPI Number	:	1558332429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL SUSAN JEFFERS LPC MED EDS

Provider Business Mailing Address
First Line	:	560 DONNA DR SW
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-3504
Country	:	US
Telephone Number	:	770-433-0322
Fax Number	:	770-433-0322

Provider Business Practice Location Address
First Line	:	1640 POWERS FERRY RD
Second Line	:	BLDG 8 STE 150
City	:	MARIETTA
State	:	GA
Zip	:	30067-5491
Country	:	US
Telephone Number	:	678-933-7386
Fax Number	:	770-433-0322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/11/2025

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