Provider Demographics
NPI:1033326293
Name:JENKINS, LAVELLE L (MA, MBA)
Entity Type:Individual
Prefix:MS
First Name:LAVELLE
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 SHIPROCK CT
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-8812
Mailing Address - Country:US
Mailing Address - Phone:407-831-2411
Mailing Address - Fax:407-831-0195
Practice Address - Street 1:2494 SHIPROCK CT
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-8812
Practice Address - Country:US
Practice Address - Phone:407-831-2411
Practice Address - Fax:407-831-0195
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 6029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health