| Doctor Name: | MRS. COWENDA SHAVONNE JEFFERSON |
| NPI Number: | 1003911348 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LPC NCC CCAADC |
| License Number: | C0101 |
| Business Practice Address: | 120 Gordon Commercial Dr Ste B Lagrange, GA - 302405753 |
| Business Phone Number: | 7068454054 |
| Business Fax Number: | 7068454430 |
| Mailing Address: | 140 N Davis Rd, Apt 223 LAGRANGE |
| State: | GA |
| Postal Code: | 302411596 |
| Phone Number: | 8109192635 |
| Fax Number: | |
| NPI Enumeration Date: | 09/13/2006 |
| NPI Last Update Date: | 09/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | C0101 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |