Provider Demographics
NPI:1689155111
Name:JENKINS, CAROLYN S (MED , LPC, NCC,)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:S
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MED , LPC, NCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6006
Mailing Address - Country:US
Mailing Address - Phone:662-561-5765
Mailing Address - Fax:
Practice Address - Street 1:304B ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2762
Practice Address - Country:US
Practice Address - Phone:662-371-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health