Provider Demographics
NPI:1144908617
Name:SANDEFER, JERMECKIA (MS)
Entity type:Individual
Prefix:
First Name:JERMECKIA
Middle Name:
Last Name:SANDEFER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 DUNBAR CAVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37044-1133
Mailing Address - Country:US
Mailing Address - Phone:615-657-4025
Mailing Address - Fax:
Practice Address - Street 1:223 DUNBAR CAVE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8830
Practice Address - Country:US
Practice Address - Phone:931-209-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health