Cowenda Shavonne Jefferson, MA LPC NCC CCAADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC006320 Issued in GA

Practice address

103 Renae LN
Hogansville, GA 30230

Phone

(762) 323-9693

NPI assigned

Sep 13, 2006

Last updated

May 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558310400000",
    "number": "1003911348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 RENAE LN",
            "city": "HOGANSVILLE",
            "state": "GA",
            "postal_code": "302303434",
            "telephone_number": "762-323-9693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 RENAE LN",
            "city": "HOGANSVILLE",
            "state": "GA",
            "postal_code": "30230",
            "telephone_number": "762-323-9693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Gordon Commercial Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "LaGrange",
            "state": "GA",
            "postal_code": "302405753",
            "country_code": "US",
            "telephone_number": "706-845-4054 x5142",
            "fax_number": "706-845-4430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "COWENDA",
        "middle_name": "SHAVONNE",
        "name_prefix": "Mrs.",
        "credential": "MA LPC NCC CCAADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2019-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "229340",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "C0101",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC006320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chantel Colmer, D.C.
• Gregory E. Freeman, DDS
• Amy Claire Griffith, MS, ATC/L, CSCS
• Hogansville Pharmacy Inc
• Individual
• Nicole Joseph
• Vishwas S Kadam, MD
• Brenton Knowlton, RPH
• Peter Mauretta, RPH
• Richard Milliron, PARAMEDIC

• Professional Counselor in Hogansville, GA
• Providers in Hogansville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.