Provider Demographics
NPI:1750689295
Name:JENKINS, SHEILA DELORIS (MA)
Entity Type:Individual
Prefix:MISS
First Name:SHEILA
Middle Name:DELORIS
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 JOHNNY LORICK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9461
Mailing Address - Country:US
Mailing Address - Phone:803-920-0473
Mailing Address - Fax:
Practice Address - Street 1:1411 BARNWELL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3566
Practice Address - Country:US
Practice Address - Phone:803-920-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional