Provider Demographics
NPI:1588203251
Name:JERKINS, WHITNEY NICOLE (ALC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICOLE
Last Name:JERKINS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-2520
Mailing Address - Country:US
Mailing Address - Phone:251-286-0707
Mailing Address - Fax:
Practice Address - Street 1:701 FORREST AVE
Practice Address - Street 2:
Practice Address - City:EAST BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-2520
Practice Address - Country:US
Practice Address - Phone:251-286-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health