Healthcare Provider Details

I. General information

NPI: 1083261432
Provider Name (Legal Business Name): DEXTER L JENKINS SR. CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 POE AVE
DAYTON OH
45414-2559
US

IV. Provider business mailing address

11 W MONUMENT AVE FL 7
DAYTON OH
45402-1274
US

V. Phone/Fax

Practice location:
  • Phone: 937-280-4631
  • Fax:
Mailing address:
  • Phone: 937-461-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number178181
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: