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General NPI Number Information
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NPI Number | 1366104390
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Entity Type | Individual
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Provider Name | MATTHEW JENKINS CDCA
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Gender | Male
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 32 PORTSMOUTH ST
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City | JACKSON
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State | OH
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Zip | 45640-1622
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Country | US
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Telephone | 740-286-2918
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Fax | 740-286-1374
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Provider Business Mailing Address
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Address Line | 500 WARD RD
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City | BIDWELL
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State | OH
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Zip | 45614-9342
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Country | US
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Telephone | 740-645-9382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.175539
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License Number State | OH
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