MEDICARE: MS. ELIZABETH MARIE JENKINS

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	779	VA

General Provider Information

NPI Number	:	1508889429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH MARIE JENKINS

Provider Business Mailing Address
First Line	:	1120 MCCONVILLE RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4534
Country	:	US
Telephone Number	:	434-237-4652
Fax Number	:	434-237-4804

Provider Business Practice Location Address
First Line	:	1120 MCCONVILLE RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4534
Country	:	US
Telephone Number	:	434-237-4652
Fax Number	:	434-237-4804

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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