MEDICARE: TORIA DAVENPORT JENKS LCMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	222Q00000X	Developmental Therapist
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1255940581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORIA DAVENPORT JENKS LCMHCA

Provider Business Mailing Address
First Line	:	118 MAPLE LN
Second Line	:
City	:	KING
State	:	NC
Zip	:	27021-9413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 CAROLINA AVE STE A
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7793
Country	:	US
Telephone Number	:	336-818-0733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	08/31/2023

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