MEDICARE: CHRISTINE LYNN JEFFREYS LCMHA

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	101Y00000X	Counselor	A15032	NC
2	101YM0800X	Mental Health Counselor	A15032	NC

General Provider Information

NPI Number	:	1760089825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LYNN JEFFREYS LCMHA

Provider Business Mailing Address
First Line	:	3532 HAMILTON MILL DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-9007
Country	:	US
Telephone Number	:	919-628-9887
Fax Number	:

Provider Business Practice Location Address
First Line	:	3532 HAMILTON MILL DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-9007
Country	:	US
Telephone Number	:	919-628-9887
Fax Number	:

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

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	08/12/2021

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