MEDICARE: WHITNEY NICOLE JERKINS ALC

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
1	101YM0800X	Mental Health Counselor	4310	AL

General Provider Information

NPI Number	:	1588203251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY NICOLE JERKINS ALC

Provider Business Mailing Address
First Line	:	701 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2520
Country	:	US
Telephone Number	:	251-286-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2520
Country	:	US
Telephone Number	:	251-286-0707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	12/11/2023

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