Provider Demographics
NPI:1003581349
Name:JENKINS, TIFFANY CATRICE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CATRICE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 MOUNT VERNON AVE APT 1007
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2651
Mailing Address - Country:US
Mailing Address - Phone:201-407-5766
Mailing Address - Fax:
Practice Address - Street 1:3999 8TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3734
Practice Address - Country:US
Practice Address - Phone:202-562-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1198026103TS0200X
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool