Provider Demographics
NPI:1407980899
Name:JENKINS, LEOLA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LEOLA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6856
Mailing Address - Country:US
Mailing Address - Phone:301-890-7721
Mailing Address - Fax:202-673-7642
Practice Address - Street 1:1250 U ST NW
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7522
Practice Address - Country:US
Practice Address - Phone:202-671-1266
Practice Address - Fax:202-673-7642
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3000151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical