| Doctor Name: | CORA BETHANE JACKSON SIEVEKA |
| NPI Number: | 1386617207 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LGSW |
| License Number: | G11552 |
| Business Practice Address: | 21770 Fdr Boulevard Lexington Park, MD - 20653 |
| Business Phone Number: | 3018624966 |
| Business Fax Number: | 3018625554 |
| Mailing Address: | Po Box 826, Trico Corporation LEXINGTON PARK |
| State: | MD |
| Postal Code: | 206530826 |
| Phone Number: | 3018624966 |
| Fax Number: | 3018625554 |
| NPI Enumeration Date: | 02/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | G11552 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |