Provider Demographics
NPI:1235571787
Name:JENKINS, KAREN WIDENHOUSE (LCMHC,LPC,LCAS,CRC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:WIDENHOUSE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCMHC,LPC,LCAS,CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 WILLOW RUN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-1002
Mailing Address - Country:US
Mailing Address - Phone:252-327-3239
Mailing Address - Fax:252-364-4803
Practice Address - Street 1:708 CROMWELL DR STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5440
Practice Address - Country:US
Practice Address - Phone:252-327-3239
Practice Address - Fax:252-364-4803
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008817101YP2500X
NC10305101YP2500X, 101Y00000X
NC3250101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10305OtherNC BOARD OF LICENSED PROFESSIONAL COUNSELORS
NCLCAS-3250OtherNC SUBSTANCE ABUSE BOARD