Cowenda Shavonne Jefferson, MA LPC NCC CCAADC
Individual provider Active NPI Professional Counselor · Hogansville, GA
NPI 1003911348 · NPPES record last updated May 20, 2019
Key facts
- NPI
- 1003911348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC006320 (GA)
- Practice address
- 103 Renae LN
Hogansville, GA 30230 - Phone
- (762) 323-9693
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 229340 | GA | MD | Counselor |
| C0101 | GA | MD | Addiction (Substance Use Disorder) Counselor |
| LPC006320 | GA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 229340 | GA | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | C0101 | GA | |
| Professional Counselor | 101YP2500X | LPC006320 | GA | Yes |
Addresses
Primary practice location
103 Renae LN
Hogansville, GA 30230
Mailing address
103 Renae LN
Hogansville, GA 30230-3434
Phone (762) 323-9693
Other practice location 1
120 Gordon Commercial Dr Ste B
LaGrange, GA 30240-5753
Phone (706) 845-4054 ext. 5142
Other providers in Hogansville, GA
- Chantel Colmer
- Gregory E. Freeman
- Amy Claire Griffith
- Hogansville Pharmacy Inc
- Individual
- Nicole Joseph
- Vishwas S Kadam
- Brenton Knowlton
- Peter Mauretta
- Richard Milliron
All providers in Hogansville, GA · Professional Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.