MEDICARE: THE JENKINS CENTER FOR EVALUATION/COUNSELING/ADVOCACY P.C.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	LPC 3039	GA

General Provider Information

NPI Number	:	1801283445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE JENKINS CENTER FOR EVALUATION/COUNSELING/ADVOCACY P.C.

Provider Business Mailing Address
First Line	:	PO BOX 490657
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-0060
Country	:	US
Telephone Number	:	770-309-5468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1871 WASHINGTON AVE
Second Line	:	SUITE 4
City	:	EAST POINT
State	:	GA
Zip	:	30344-4128
Country	:	US
Telephone Number	:	770-309-5468
Fax Number	:

Authorized Official
Title or Position	:	LICENSENED PROFESSIONAL COUNSELOR
Name	:	MR. JOHNNIE L JENKINS III
Credential	:	MA
Telephone Number	:	770-309-5468

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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