Provider Demographics
NPI:1023356243
Name:JEFFERS, RODERICK BOHANAN (LMHC)
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:BOHANAN
Last Name:JEFFERS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WITTER AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1331
Mailing Address - Country:US
Mailing Address - Phone:585-665-2623
Mailing Address - Fax:
Practice Address - Street 1:4194 BOLIVAR RD
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9325
Practice Address - Country:US
Practice Address - Phone:585-665-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health