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General NPI Number Information
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NPI Number | 1811409899
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Entity Type | Individual
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Provider Name | LYDIA R JENKINS CDCA
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Gender | Female
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 15221 ST. RT. 124
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City | PIKETON
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State | OH
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Zip | 45661
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Country | US
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Telephone | 740-961-1295
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 STATE ROUTE 522
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City | WHEELERSBURG
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State | OH
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Zip | 45694-8542
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Country | US
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Telephone |
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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 | QMHS
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CMS
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License Number State | OH
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Taxonomy #3
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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.167760
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License Number State | OH
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