Provider Demographics
NPI:1780018119
Name:JENKINS, STACEY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BOWDOIN MILL IS
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1263
Mailing Address - Country:US
Mailing Address - Phone:207-837-6599
Mailing Address - Fax:
Practice Address - Street 1:9 BOWDOIN MILL IS
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1263
Practice Address - Country:US
Practice Address - Phone:207-837-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional