Provider Demographics
NPI:1275010845
Name:TELESHIA L JENKINS LPC
Entity Type:Organization
Organization Name:TELESHIA L JENKINS LPC
Other - Org Name:TELESHIA L JENKINS LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TELESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:478-919-3173
Mailing Address - Street 1:614 AMERICAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-2373
Mailing Address - Country:US
Mailing Address - Phone:478-919-3173
Mailing Address - Fax:478-225-6404
Practice Address - Street 1:614 AMERICAN BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2373
Practice Address - Country:US
Practice Address - Phone:478-919-3173
Practice Address - Fax:478-225-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALP008500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003173335AMedicaid