Provider Demographics
NPI:1629239066
Name:JENKINS, DAVE (DMIN, LMFT)
Entity Type:Individual
Prefix:DR
First Name:DAVE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DMIN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OLDE GREENWICH DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4002
Mailing Address - Country:US
Mailing Address - Phone:540-300-1973
Mailing Address - Fax:
Practice Address - Street 1:150 OLDE GREENWICH DR
Practice Address - Street 2:SUITE 211
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4063
Practice Address - Country:US
Practice Address - Phone:540-300-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001278106H00000X, 106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist