Provider Demographics
NPI:1760079446
Name:JENKINS, ALICEA R (LPC)
Entity Type:Individual
Prefix:
First Name:ALICEA
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15768
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23328-5768
Mailing Address - Country:US
Mailing Address - Phone:757-630-2809
Mailing Address - Fax:
Practice Address - Street 1:524 ALBEMARLE DR STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5500
Practice Address - Country:US
Practice Address - Phone:757-630-2809
Practice Address - Fax:833-398-2607
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008517101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor