Healthcare Provider Details

I. General information

NPI: 1972395226
Provider Name (Legal Business Name): CASSIDY JENKINS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6841 FOREST HILL AVE UNIT 184
RICHMOND VA
23225-1603
US

IV. Provider business mailing address

6841 FOREST HILL AVE
RICHMOND VA
23225-1603
US

V. Phone/Fax

Practice location:
  • Phone: 985-250-1812
  • Fax:
Mailing address:
  • Phone: 985-250-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0805002663
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number0805002663
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0805002663
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0805002663
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number0805002663
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0805002663
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0805002663
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: