Healthcare Provider Details

I. General information

NPI: 1023308079
Provider Name (Legal Business Name): JENNICA RACHEL JENKINS PSYD, LPC, LPCC, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 E ROSEVILLE PKWY STE 140
ROSEVILLE CA
95661-7980
US

IV. Provider business mailing address

2351 SUNSET BLVD # 170-241
ROCKLIN CA
95765-4338
US

V. Phone/Fax

Practice location:
  • Phone: 916-747-3799
  • Fax:
Mailing address:
  • Phone: 916-747-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC6072
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number50164430
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number26
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberEXAM PASS # 275107
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPSYD CCU SANTA ANA
License Number State
# 6
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberTRAUMA AND LOSS CERT
License Number State
# 7
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberADOLESCENT
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: