Provider Demographics
NPI:1164032942
Name:JENKINS, CHARLES LEE JR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEE
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 VERDANA LOOP
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2733
Mailing Address - Country:US
Mailing Address - Phone:301-305-8511
Mailing Address - Fax:
Practice Address - Street 1:4705 VERDANA LOOP
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2733
Practice Address - Country:US
Practice Address - Phone:301-305-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional