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General NPI Number Information
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NPI Number | 1790420537
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Entity Type | Individual
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Provider Name | NICOLE LESTER JENKINS
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Gender | Female
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 233 S 6TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3749
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Country | US
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Telephone | 267-382-5828
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Fax |
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Provider Business Mailing Address
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Address Line | 815 ELMWOOD AVE
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City | SHARON HILL
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State | PA
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Zip | 19079-1602
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Country | US
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Telephone | 215-783-8184
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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