Provider Demographics
NPI:1568934933
Name:JENKINS, MELISSA R (PSCD, CSC, PCT)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PSCD, CSC, PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 CURTIS RD LOT 4
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-7055
Mailing Address - Country:US
Mailing Address - Phone:912-825-4362
Mailing Address - Fax:
Practice Address - Street 1:580 CURTIS RD LOT 4
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-7055
Practice Address - Country:US
Practice Address - Phone:912-825-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X, 174V00000X, 372600000X, 374K00000X, 374T00000X, 376J00000X, 101YP1600X, 101YP1600X
KY221700000X, 374U00000X, 376K00000X
372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174V00000XOther Service ProvidersClinical Ethicist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA2689HHCOtherHOLISTIC HEALTH COACH
GAPCT2689OtherPATIENT CARE SPEACIALIST
TXD.PSCOtherDOCTOR OF PASTORAL SCIENCE & MEDICINE
GACSC2689OtherCERTIFIED PASTORAL COUNSELOR