Healthcare Provider Details

I. General information

NPI: 1285829077
Provider Name (Legal Business Name): JENKINS COUNSELING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 THOMPSON GREENS LN
CHARLOTTE NC
28212-7949
US

IV. Provider business mailing address

7205 THOMPSON GREENS LN
CHARLOTTE NC
28212-7949
US

V. Phone/Fax

Practice location:
  • Phone: 704-458-9185
  • Fax: 704-631-4765
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY L JENKINS
Title or Position: OWNER
Credential: MS, LPC
Phone: 704-458-9185