Provider Demographics
NPI:1194391102
Name:JENKINS, LEAHANN MICHELLE (RBT)
Entity Type:Individual
Prefix:
First Name:LEAHANN
Middle Name:MICHELLE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:LEAHANN
Other - Middle Name:MICHELLE
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2606 AVENTURA BLVD APT 410
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8236
Mailing Address - Country:US
Mailing Address - Phone:434-386-7466
Mailing Address - Fax:
Practice Address - Street 1:2606 AVENTURA BLVD APT 410
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-8236
Practice Address - Country:US
Practice Address - Phone:434-386-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABACB651493106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician