Provider Demographics
NPI:1073247433
Name:JENKINS, STEPHEN (LMSW, LADAC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LMSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CINDY LN
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-9429
Mailing Address - Country:US
Mailing Address - Phone:417-684-0455
Mailing Address - Fax:
Practice Address - Street 1:4260 STOCKTON DR STE A
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2915
Practice Address - Country:US
Practice Address - Phone:501-389-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YA0400X
AR12153-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)