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General NPI Number Information
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NPI Number | 1659637007
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Entity Type | Individual
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Provider Name | KIM YVONNE JENKINS MSW,P-LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 234 MAIN ST E
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City | AHOSKIE
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State | NC
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Zip | 27910-3418
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Country | US
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Telephone | 252-862-0002
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Fax | 252-862-0007
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Provider Business Mailing Address
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Address Line | 201 MORRIS RD
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City | AHOSKIE
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State | NC
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Zip | 27910-9783
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Country | US
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Telephone | 252-287-9948
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P006804
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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