Healthcare Provider Details

I. General information

NPI: 1164625034
Provider Name (Legal Business Name): AISHA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 TENNESSEE ST
VALLEJO CA
94590-4453
US

IV. Provider business mailing address

623 DANIELS AVE
VALLEJO CA
94590-3010
US

V. Phone/Fax

Practice location:
  • Phone: 707-554-2397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: