Provider Demographics
NPI:1497097935
Name:JENKINS, CYNTHIA DARLENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DARLENE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W BOND ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-3530
Mailing Address - Country:US
Mailing Address - Phone:843-260-8824
Mailing Address - Fax:
Practice Address - Street 1:200 ELM ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5118
Practice Address - Country:US
Practice Address - Phone:843-488-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4894101YP2500X
SC86699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional