Provider Demographics
NPI:1639242423
Name:JENKINS, LORRAINE K (CAC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:K
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35572 POPLAR NECK RD
Mailing Address - Street 2:
Mailing Address - City:WILLARDS
Mailing Address - State:MD
Mailing Address - Zip Code:21874-1340
Mailing Address - Country:US
Mailing Address - Phone:410-835-2977
Mailing Address - Fax:
Practice Address - Street 1:WACS
Practice Address - Street 2:11827 OCEAN GATEWAY
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842
Practice Address - Country:US
Practice Address - Phone:410-213-0202
Practice Address - Fax:410-213-1408
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDACO164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS013Medicare ID - Type Unspecified