MEDICARE: MRS. STACEY JENKINS LCPC

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	101YP2500X	Professional Counselor	CC4054	ME

General Provider Information

NPI Number	:	1780018119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEY JENKINS LCPC

Provider Business Mailing Address
First Line	:	9 BOWDOIN MILL IS
Second Line	:
City	:	TOPSHAM
State	:	ME
Zip	:	04086-1263
Country	:	US
Telephone Number	:	207-837-6599
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 BOWDOIN MILL IS
Second Line	:
City	:	TOPSHAM
State	:	ME
Zip	:	04086-1263
Country	:	US
Telephone Number	:	207-837-6599
Fax Number	:

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	11/05/2023

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