Provider Demographics
NPI:1073082194
Name:JENKINS, MELISSA MARGARET (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARGARET
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6999 REISTERSTOWN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1492
Mailing Address - Country:US
Mailing Address - Phone:667-600-3202
Mailing Address - Fax:
Practice Address - Street 1:6999 REISTERSTOWN RD STE 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1492
Practice Address - Country:US
Practice Address - Phone:667-600-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD096701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical