Healthcare Provider Details

I. General information

NPI: 1649813668
Provider Name (Legal Business Name): DEBRA ANN JENKINS LCMHC,LMHC, LPC,LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 ROUTE 130 APT B207
NORTH BRUNSWICK NJ
08902-5068
US

IV. Provider business mailing address

2775 ROUTE 130 APT B207
NORTH BRUNSWICK NJ
08902-5068
US

V. Phone/Fax

Practice location:
  • Phone: 919-931-7446
  • Fax: 919-500-7851
Mailing address:
  • Phone: 919-931-7446
  • Fax: 919-500-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-25944
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14979
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01745
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC1000607
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01164500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: