Healthcare Provider Details

I. General information

NPI: 1366874075
Provider Name (Legal Business Name): VALERIE LOWE JENKINS CSW03593
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 01/24/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 HENRY HILL DR STE 109
JACKSON MS
39204-2046
US

IV. Provider business mailing address

537 VINELAND DR
JACKSON MS
39212-5739
US

V. Phone/Fax

Practice location:
  • Phone: 601-714-2821
  • Fax: 855-341-7510
Mailing address:
  • Phone: 601-842-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW03593
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: