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General NPI Number Information
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NPI Number | 1679438212
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Entity Type | Individual
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Provider Name | TAWANDA JENKINS
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Gender | Female
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 110 DEWITT ST
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City | NEW HAVEN
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State | CT
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Zip | 06519-2131
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Country | US
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Telephone | 203-410-8941
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Fax |
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Provider Business Mailing Address
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Address Line | 110 DEWITT ST
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City | NEW HAVEN
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State | CT
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Zip | 06519-2131
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Country | US
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Telephone | 203-410-8941
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | CT
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