MEDICARE: JOEANN JENKINS COUNSELOR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704014027	VA

General Provider Information

NPI Number	:	1437871951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEANN JENKINS COUNSELOR

Provider Business Mailing Address
First Line	:	341 MAIN ST
Second Line	:
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-1345
Country	:	US
Telephone Number	:	757-356-1813
Fax Number	:	757-356-1813

Provider Business Practice Location Address
First Line	:	341 MAIN ST
Second Line	:
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-1345
Country	:	US
Telephone Number	:	757-356-1813
Fax Number	:	757-356-1813

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

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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