MEDICARE: HARRIET DIANE JENKINS LCSW

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	1041C0700X	Clinical Social Worker	C002645	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770501058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIET DIANE JENKINS LCSW

Provider Business Mailing Address
First Line	:	2820 NORTHBRIDGE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6517
Country	:	US
Telephone Number	:	336-768-8670
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 WEST ELM STREET
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-3313
Country	:	US
Telephone Number	:	336-575-3747
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/02/2007

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