Provider Demographics
NPI:1790914802
Name:JENKINS, JAMES LOUIS (LMHC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LOUIS
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BURNET PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9430
Mailing Address - Country:US
Mailing Address - Phone:828-691-2188
Mailing Address - Fax:
Practice Address - Street 1:17 PACIFIC ST STE B
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2784
Practice Address - Country:US
Practice Address - Phone:828-691-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health