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NPI Code Detail

MEDICARE: DERRICK V JENKINS LCDCIII

MEDICARE: DERRICK V JENKINS LCDCIII
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor081050OH

General Provider Information

NPI Number : 1437329588
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK V JENKINS LCDCIII
Provider Business Mailing Address
First Line : 885 E BUCHTEL AVE
Second Line :
City : AKRON
State : OH
Zip : 44305-2338
Country : US
Telephone Number : 330-535-8116
Fax Number : 330-365-3375
Provider Business Practice Location Address
First Line : 885 E BUCHTEL AVE
Second Line :
City : AKRON
State : OH
Zip : 44305-2338
Country : US
Telephone Number : 330-535-8116
Fax Number : 330-365-3375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2008
Last Update Date : 03/19/2024

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