Provider Demographics
NPI:1275967234
Name:JENKINS, JILL C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 WYKESHIRE CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5835
Mailing Address - Country:US
Mailing Address - Phone:678-575-7270
Mailing Address - Fax:
Practice Address - Street 1:1375 IDLEWOOD PARC XING
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7836
Practice Address - Country:US
Practice Address - Phone:678-637-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0032751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical