Provider Demographics
NPI:1275232241
Name:JENKINS, LASHARRA (LMSW)
Entity Type:Individual
Prefix:
First Name:LASHARRA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LASHARRA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1139 TIANA ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-1249
Mailing Address - Country:US
Mailing Address - Phone:662-570-8138
Mailing Address - Fax:
Practice Address - Street 1:1139 TIANA ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-1249
Practice Address - Country:US
Practice Address - Phone:662-570-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010108104100000X
TX107039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker